Orbitozygomatic approach and extradural temporopolar approach: Operative techniques and tips

Abstract

The orbitozygomatic approach(OZA)and extradural temporopolar approach(EDTPA)are standard skull base techniques to access the central skull base from the anterolateral direction. This study discusses operative techniques and tips for these approaches. The OZA provides wide operative field and working angle. Frontozygomatic osteotomy based on creating guide burr holes in the orbital wall and cutting bone using a diamond-coated threadwire saw is safe and results in minimum bone gap in the malar eminence. The EDTPA provides a surgical corridor to the interpeduncular cistern via the opened avernous sinus. Peeling of the dura propria from the lateral wall of the cavernous sinus is started at the surgically exposed junction between the dura propria and the inner membrane between the superior orbital fissure and foramen rotundum instead of cutting the dura propria to avoid injuring the cranial nerves.