Technical note: Orbitozygomatic craniotomy using an ultrasonic osteotome for precise osteotomies.
BACKGROUND
The orbitozygomatic craniotomy is a fundamental procedure in neurosurgery, allowing access to orbital and skull base pathology.


OBJECTIVE
Determine the feasibility of using an ultrasonic osteotome to safely perform orbitozygomatic osteotomies in patients with intracranial pathology.


METHODS
The medical records of patients undergoing orbitozygomatic craniotomy using an ultrasonic osteotome (Aesculap BoneScalpel™) for tumor resection at Johns Hopkins Hospital between November 2009 and March 2013 were retrospectively reviewed.


RESULTS
Six patients underwent orbitozygomatic craniotomy for tumor resection using an ultrasonic osteotome at the Johns Hopkins Hospital during the study period. All patients were female and the average age was 53.2 years. Patients were followed for an average of 375 days. There were two cases of transient diplopia. There were no cases of periorbital violation, orbital injury, enophthalmos, or orbital hematoma. Post-operative imaging showed the cuts were well opposed and no cosmetic issues were encountered.


CONCLUSIONS
Use of an ultrasonic osteotome allows for precise cuts under direct visualization with minimal risk to critical adjacent structures in our cohort of patients undergoing a two-piece orbitozygomatic craniotomy. This appears to be a safe instrument for osteotomy creation in skull base approaches.
Departments of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, USA.
Jacob
J
Ruzevick
Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Shaan M
SM
Raza
Departments of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, USA.
Pablo F
PF
Recinos
Departments of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, USA.
Kaisorn
K
Chaichana
Departments of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, USA.
Gustavo
G
Pradilla
Departments of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, USA.
Jennifer E
JE
Kim
Departments of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, USA; Departments of Oncology, The Johns Hopkins University School of Medicine, Baltimore, USA.
Alessandro
A
Olivi
Departments of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, USA; Departments of Oncology, The Johns Hopkins University School of Medicine, Baltimore, USA.
Jon
J
Weingart
Jefferson University, Department of Neurosurgery, Philadelphia, PA, USA.
James
J
Evans
Departments of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, USA; Departments of Oncology, The Johns Hopkins University School of Medicine, Baltimore, USA.
Alfredo
A
Quinones-Hinojosa
Departments of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, USA; Departments of Oncology, The Johns Hopkins University School of Medicine, Baltimore, USA. Electronic address: mlim3@jhmi.edu.
Michael
M
Lim
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003397:Craniopharyngioma / Q000601:surgery*; D003399:Craniotomy / Q000295:instrumentation*; D004172:Diplopia; D005260:Female; D006801:Humans; D008577:Meningeal Neoplasms / Q000601:surgery*; D008579:Meningioma / Q000601:surgery*; D008875:Middle Aged; D009915:Orbit / Q000601:surgery*; D010027:Osteotomy / Q000295:instrumentation*; D010911:Pituitary Neoplasms / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D059708:Ultrasonic Surgical Procedures / Q000295:instrumentation*; D015050:Zygoma / Q000601:surgery*
Craniotome; Orbitozygomatic approach; Ultrasonic osteotome