title: Extended orbitozygomatic approach to the skull base to improve access to the cavernous sinus and optic chiasm.
abstract: BACKGROUND
  The orbitozygomatic approach to the skull base has evolved over the past century, with a surge in development during the past 20 years. We describe an extension of this technique involving removal of the most inferior portion of the temporal bone to the level of the internal carotid artery as it enters the carotid canal, to further facilitate exposure of tumors in this region.
  
  
  METHODS
  We performed the extended orbitozygomatic approach in a series of 17 patients with a variety of neoplastic lesions. Our case series was reviewed in a retrospective fashion, and our surgical approach is described. The approach is performed safely and effectively by using the spine of the sphenoid and middle meningeal artery as landmarks and then resecting the temporal bone from the temporal craniotomy site to the carotid canal.
  
  
  RESULTS
  The extended orbitozygomatic approach has been performed at our institution over the past 6 years and has provided significantly improved access to this region of the skull base, facilitating tumor extirpation in our patient population without an increase in complications.
  
  
  CONCLUSIONS
  The extended orbitozygomatic approach further improves exposure and facilitates surgical dissection in patients with neoplasms of the cavernous sinus, sellar region, interpeduncular region, and upper clivus. The improved access without an increase in complications supports the inclusion of the extended orbitozygomatic approach in the armamentarium of the skull base surgeon.
authors.affiliation: Department of Otolaryngology--Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, USA.
authors.forename: Allison Teresa
authors.initials: AT
authors.lastname: Pontius
authors.forename: Yadranko
authors.initials: Y
authors.lastname: Ducic
mesh_terms: D002426:Cavernous Sinus / Q000601:surgery*; D003388:Cranial Fossa, Posterior / Q000601:surgery*; D006391:Hemangioma / Q000601:surgery; D006801:Humans; D008577:Meningeal Neoplasms / Q000601:surgery; D008579:Meningioma / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D009442:Neurilemmoma / Q000601:surgery; D009897:Optic Chiasm / Q000601:surgery*; D019574:Optic Nerve Neoplasms / Q000601:surgery; D009915:Orbit / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D010911:Pituitary Neoplasms / Q000601:surgery; D012189:Retrospective Studies; D012658:Sella Turcica / Q000601:surgery; D013701:Temporal Bone / Q000601:surgery; D015050:Zygoma / Q000601:surgery*