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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] [What about the content of this article? (0)] [Affiliation(s)] [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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