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Neal E, Pressman E, Athienitis A, Turner A, Ma S, Rao G, Primiani C, Agarwalla P, van Loveren H, Agazzi S. Indications and Safety of the Zygomatic Osteotomy in Middle Cranial Fossa Surgery: A Retrospective Cohort Review. J Neurol Surg B Skull Base 2018; 80:225-231. [PMID: 31143563 DOI: 10.1055/s-0038-1668519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 07/07/2018] [Indexed: 10/28/2022] Open
Abstract
Background Zygomatic osteotomy, an adjunct to middle cranial fossa (MCF) surgical approaches, improves the superior-inferior angle of approach and minimizes temporal lobe retraction. However, a decision-making algorithm for selective use of the zygomatic osteotomy and the impact of the zygomatic osteotomy on surgical complications have not been well documented. Objective We described an algorithm for deciding whether to use a zygomatic osteotomy in MCF surgery and evaluated complications associated with a zygomatic osteotomy. Methods A retrospective review of MCF cases over 11 years at our academic tertiary referral center was conducted. Demographic variables, tumor characteristics, surgical details, and postoperative complications were extracted. Results Of the 87 patients included, 15 (17%) received a zygomatic osteotomy. Surgical trajectory oriented from anterior to posterior (A-P) was significantly correlated with the use of the zygomatic osteotomy. Among the cases approached from A-P, we found (receiver-operating characteristic curve) that the cut-off tumor size that predicted a zygomatic osteotomy was 30 mm. Of the 87 cases included, 15 patients had a complication. The multivariate logistic regression model failed to reveal any significant correlation between complications and zygomatic osteotomies. Conclusions We found that the most important factor determining the use of a zygomatic osteotomy was anticipated trajectory. A-P approaches were most highly correlated with zygomatic osteotomy. Within those cases, a lesion size cut-off of 30 mm was the secondary predicting factor of zygomatic osteotomy use. The odds of suffering a surgical complication were not significantly increased by use of zygomatic osteotomy.
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Affiliation(s)
- Elliot Neal
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, United States
| | - Elliot Pressman
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, United States
| | - Alexia Athienitis
- Muma College of Business, University of South Florida, Tampa, Florida, United States
| | - Adam Turner
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, United States
| | - Shunchang Ma
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, United States.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Gautam Rao
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, United States
| | - Christopher Primiani
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, United States
| | - Pankaj Agarwalla
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, United States
| | - Harry van Loveren
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, United States
| | - Siviero Agazzi
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, United States
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Campero A, Villalonga JF, Elizalde RL, Ajler P, Martins C. Transzygomatic approach plus mini-peeling of middle fossa for devascularization of sphenoid wing meningiomas. Technical note. Surg Neurol Int 2018; 9:140. [PMID: 30105134 PMCID: PMC6069374 DOI: 10.4103/sni.sni_135_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 06/18/2018] [Indexed: 11/06/2022] Open
Abstract
Background: Sphenoid wing meningiomas account for 20% of supratentorial meningiomas. The main supply of these tumors is provided by branches of the middle and accessory meningeal arteries. Surgical resection of meningiomas requires early tumor devascularization. Our objective is to present the role of transzygomatic approach plus mini-peeling of the anterior third of the middle fossa in the extradural identification and coagulation of branches of middle and accessory meningeal arteries involved in tumor supply. Methods: Ten formalin-fixed, silicone-injected cadaveric heads were used. On each side a transzygomatic approach plus mini-peeling of the anterior third of the middle fossa was performed. Between 2005 and 2017, the authors applied this technique for the resection of sphenoid wing meningiomas in 28 patients. Results: The mean age of patients was 54 years. Thirteen tumors could be classified as medial-third type, 6 as middle-third type, and 4 tumors were lateral-third type. Five tumors represented combined types. Of these, 3 tumors involved the medial and middle-third of the sphenoid wing and 2 involved the entire wing. Surgical resection was classified as Simpson I/II in 24 patients (86%). There were no permanent deficits or postoperative mortality. Conclusions: The transzygomatic approach combined with mini-peeling of the anterior third of the middle fossa is effective in allowing early devascularization of sphenoid wing meningiomas. These maneuvers are particularly important during resection of large tumors.
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Affiliation(s)
- Alvaro Campero
- Department of Neurosurgery, Hospital Padilla, Tucuman, Argentina.,Universidad Nacional de Tucuman, Argentina
| | | | | | - Pablo Ajler
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Argentina
| | - Carolina Martins
- Department of Neurosurgery, Hospital Metropolitano Oesta Pelópidas Silveira, Recife, Brasil
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Motoyama Y, Hironaka Y, Nishimura F, Gurung P, Sasaki R, Takeshima Y, Matsuda R, Tamura K, Nakagawa I, Park YS, Nakase H. Quantitative analysis of the trajectory of simulated basilar apex aneurysms through the internal carotid artery to assess the need for an orbitozygomatic approach. Acta Neurochir (Wien) 2017; 159:85-92. [PMID: 27848082 PMCID: PMC5177669 DOI: 10.1007/s00701-016-3018-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/03/2016] [Indexed: 11/28/2022]
Abstract
Background The aim of this study was to identify the correlation between the location of the internal carotid artery (ICA) and the need for an orbitozygomatic approach (OZA) when approaching a basilar apex (BX) aneurysm. Materials and methods By imaging the virtual trajectory to access the basilar artery (BA) through the ICA, the correlations among the height of the BX, the height and lateral breadth of the bifurcation of the ICA, and the need for removal of the orbital rim or zygomatic arch were investigated using three-dimensional computed tomography angiography (3DCTA) data of approximately 80 random samples not limited to BX aneurysms. Furthermore, the utility of 3D simulation to determine the need for the OZA was verified using data from five patients with BX aneurysms. Results The height of the bifurcation of the ICA was inversely correlated and the height of the BX was positively correlated with the need for the OZA (both p < 0.017). Among patients undergoing surgery, clipping was successfully performed without the OZA in two patients in whom the distance from the simulated skull point on the extended line from the BX through the bifurcation of the ICA was more than 4 cm from the zygoma and orbital rim. Conclusions It is necessary to determine the spatial relationship between the basilar artery and the ICA to decide whether the OZA is needed for surgery. Correlations of the height of the ICA and BX with the need for the OZA were not very strong individually, though they were significant. Therefore, simulation using 3DCTA appears to be important for planning the surgical approach for the treatment of BX aneurysms.
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Affiliation(s)
- Yasushi Motoyama
- Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Yasuo Hironaka
- Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Fumihiko Nishimura
- Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | | | - Ryota Sasaki
- Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Yasuhiro Takeshima
- Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Ryosuke Matsuda
- Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Kentaro Tamura
- Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Young-Su Park
- Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
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Martin AG, Abdullah JY, Jaafar A, Ghani ARI, Rajion ZA, Abdullah JM. Addition of zygomatic arch resection in decompressive craniectomy. J Clin Neurosci 2015; 22:735-9. [DOI: 10.1016/j.jocn.2014.09.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 09/19/2014] [Indexed: 11/25/2022]
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Son BC, Lee SW, Kim S, Hong JT, Sung JH, Yang SH. Transzygomatic approach with intraoperative neuromonitoring for resection of middle cranial fossa tumors. J Neurol Surg B Skull Base 2013; 73:28-35. [PMID: 23372992 DOI: 10.1055/s-0032-1304561] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 09/01/2011] [Indexed: 10/28/2022] Open
Abstract
The authors reviewed the surgical experience and operative technique in a series of 11 patients with middle fossa tumors who underwent surgery using the transzygomatic approach and intraoperative neuromonitoring (IOM) at a single institution. This approach was applied to trigeminal schwannomas (n = 3), cavernous angiomas (n = 3), sphenoid wing meningiomas (n = 3), a petroclival meningioma (n = 1), and a hemangiopericytoma (n = 1). An osteotomy of the zygoma, a low-positioned frontotemporal craniotomy, removal of the remaining squamous temporal bone, and extradural drilling of the sphenoid wing made a flat trajectory to the skull base. Total resection was achieved in 9 of 11 patients. Significant motor pathway damage can be avoided using a change in motor-evoked potentials as an early warning sign. Four patients experienced cranial nerve palsies postoperatively, even though free-running electromyography of cranial nerves showed normal responses during the surgical procedure. A simple transzygomatic approach provides a wide surgical corridor for accessing the cavernous sinus, petrous apex, and subtemporal regions. Knowledge of the middle fossa structures is essential for anatomic orientation and avoiding injuries to neurovascular structures, although a neuronavigation system and IOM helps orient neurosurgeons.
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Affiliation(s)
- Byung Chul Son
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
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