title: The orbitozygomatic stich: A technical modification of the lateral supraorbital approach.
abstract: BACKGROUND
  The lateral supraorbital approach (LSO) provides access to a variety of pathologies including anterior and some posterior circulation aneurysms, sellar and suprasellar lesions, and anterior fossa tumors. Technical modifications of LSO improve the surgical exposure of the skull base.
  
  
  METHODS
  We retrospectively analyzed 73 consecutive patients treated by the senior author (Juha A. Hernesniemi), at the Department of Neurosurgery, Helsinki University Hospital in Helsinki, Finland from May 2013 to October 2013. This study cohort underwent a modified LSO to access anterior circulation aneurysms, sellar and suprasellar tumors, and anterior fossa tumors. The studied population comprised 30 men and 43 women, with a mean age at treatment of 54 years (9-83 years).
  
  
  RESULTS
  LSO was successfully used to access anterior circulation aneurysms in 59 (81%) patients, 10 (14%) patients with anterior cranial fossa tumors, and 4 (5%) patients with suprasellar tumors. The skull base drilling provided a mean of 6.8 mm (1.7-22 mm) in increased exposure.
  
  
  CONCLUSIONS
  LSO provides adequate access to vascular and neoplastic lesions of the anterior cranial fossa, by drilling approximately 6.8 mm (1.7-22 mm) of the lateral orbital wall and sphenoid wing. This enhances surgical exposure and trajectory. An additional trick while performing an LSO is to place a single or multiple stiches (orbitozygomatic stich) at the base of the dura once opened, eliminating the dead space between the dura and anterior skull base.
authors.affiliation: Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Miroslava
authors.initials: M
authors.lastname: Lazukova
authors.affiliation: Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Neurosurgery, University Central Hospital Antonio Maria Pineda, Barquisimeto, Venezuela.
authors.forename: Hugo
authors.initials: H
authors.lastname: Andrade-Barazarte
authors.affiliation: Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Mahkham
authors.initials: M
authors.lastname: Makhamov
authors.affiliation: Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Juri
authors.initials: J
authors.lastname: Kivelev
authors.affiliation: Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Neurosurgery, Stroke Center, Bergmannstrost Hospital, Halle, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Goehre
authors.affiliation: Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Behnam Rezai
authors.initials: BR
authors.lastname: Jahromi
authors.affiliation: Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Neurosurgery, Loyola University Medical Center, Maywood, IL, USA.
authors.forename: Tarik F
authors.initials: TF
authors.lastname: Ibrahim
authors.affiliation: Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Araujo
authors.affiliation: Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Hanna
authors.initials: H
authors.lastname: Lehto
authors.affiliation: Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Juha A
authors.initials: JA
authors.lastname: Hernesniemi
keywords: Aneurysm; lateral supraorbital approach; orbitozygomatic stich