The transzygomatic approach: an anatomical study.

The transzygomatic approach has been utilised to facilitate neurosurgical access to the skull base for a number of years. Advocates of the technique claim the additional access gained provides wider exposure of the neurosurgical pathology and improved visualisation of adjacent vital neurovascular structures. The aim of this study was to photographically demonstrate the technique and to highlight the anatomical areas to which access can be improved. A morphological cadaver study was undertaken. Specific intracranial structures in the vicinity of the skull base were targeted and exposure was compared with and without the zygoma in position. This study demonstrates the increase in exposure of the basilar bifurcation (via a transsylvian approach) and the P2 segment of the posterior cerebral artery (via a subtemporal approach) that can be achieved and the improved access to adjacent anatomical compartments. It can be concluded that the transzygomatic approach is a relatively simple technique which can readily increase exposure of the skull base. It also provides simultaneous access to the superior pole of the infratemporal fossa, the pterygopalatine fossa and the orbit.