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Journal of Neurosurgical Sciences 2001 March;45(1):19-28

Copyright © 2001 EDIZIONI MINERVA MEDICA

language: English

Frontotemporal orbitozygomatic craniotomy to expose the cavernous sinus and its surrounding regions. Microsurgical anatomy

Jian F. Z. 1, 2, Santoro A. 1, Innocenzi G. 3, Wang X. W. 2, Liu S. S. 2, Cantore G. 1, 3

1 Department of Neurosurgical Sciences, Neurosurgery I, University of Rome “La Sapienza”, Rome, Italy; 2 Department of Neurosurgery, Beijing Hospital, Beijng, China; 3 IRCCS Neuromed. Pozzilli (IS), Italy


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Background. The micro­sur­gi­cal anat­o­my of the cav­ern­ous ­sinus and its sur­round­ing ­regions ­were exam­ined via fron­to­tem­po­ral orbit­o­zy­go­mat­ic (­FTOZ) cran­i­ot­o­my. Combined ­with oth­er ­deep oste­ot­o­mies, the pos­sibil­ity of expos­ing the pet­ro­cli­val ­region and bas­i­lar ­artery was ­also ­explored.
Methods. The ­study was ­made on 20 ­sides of 10 cadav­er­ic spec­i­mens ­fixed ­with for­mal­in, ­with the ­help of the sur­gi­cal micro­scope (mag­nifi­ca­tion 5-15).
Results. The ­FTOZ was per­formed ­with fron­to­tem­po­ral and orbit­o­zy­go­mat­ic ­flaps. Extradurally, V2, V3, the tri­gem­i­nal gan­gli­on, the pos­te­ri­or ver­ti­cal seg­ment of the intra­ca­ver­nous ICA and the VI ­nerve ­were ­exposed by ­FTOZ cran­i­ot­o­my. By fur­ther remov­al of the ­petrous ­apex (Kawase’s tri­an­gle), expo­sure ­could be extend­ed to the pet­ro­cli­val ­region; ­with ante­ri­or mod­ifi­ca­tion of the micro­scop­ic ­light, in 50% of the spec­i­mens, expo­sure ­reached as low as the con­ver­gence of the ver­te­bral arter­ies. The ante­ri­or ­part of the cav­ern­ous ­sinus and the orbi­tal ­apex ­were exam­ined by remov­ing the ante­ri­or cli­noid pro­cess, orbi­tal ­roof and unroof­ing the ­optic ­canal. Intradurally, the intra­pe­dun­cu­lar fos­sa (­upper 1/3 of the cli­vus) was exam­ined. The intra­ca­ver­nous cra­ni­al ­nerves and ves­sels ­were stud­ied via lat­er­al and super­i­or ­wall approach­es. By remov­ing ­both the ante­ri­or and pos­te­ri­or cli­noid pro­cess­es togeth­er, in 80% of the spec­i­mens, the expo­sure ­could be car­ried as far as the mid­point of the bas­i­lar ­artery.
Conclusions. ­FTOZ cran­i­ot­o­my ­could be ­used to ­treat ­lesions involv­ing the cav­ern­ous ­sinus and its sur­round­ing ­regions. Incorporated ­with the ­petrous apec­to­my, it ­could be ­used to ­expose the pet­ro­cli­val ­region and, in select­ed cas­es, expo­sure ­could be extend­ed to the con­ver­gence of the ver­te­bral arter­ies. Combined ­with ante­ri­or and pos­te­ri­or cli­noi­dec­to­mies, it ­could ­also be ­used to ­treat mid­point ­regions of the bas­i­lar ­artery.

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