Fronto-temporal approach with orbito-zygomatic removal. Surgical anatomy.

Removal of the orbital rim and the zygomatic arch can be associated with fronto-temporal craniotomy to gain additional space, so as to decrease cerebral retraction. In order to quantify the gain provided by this enlarged approach, the authors underwent anatomical studies comparing the field view angle of various intracranial targets with and without orbito-zygomatic removal, in 11 fresh human cadavers with the brain in situ. The field view angle was increased, thanks to orbito-zygomatic removal, on average, by 75% in the sub-frontal approach, 46% in the pterional approach, and 86% in the sub-temporal approach. Such approaches can be very useful for access to difficult lesions located in the vicinity of the skull base. In the last 3 years 21 patients were operated upon using this technique, with excellent results.