Orbitozygomatic Craniotomy with Modified Zabramski's Technique: A Technical Note and Anatomic and Clinical Findings.
BACKGROUND
The surgical technique of orbitozygomatic craniotomy reported by Zabramski et al. is an excellent procedure, facilitating wide surgical exposure, easy orbital reconstruction, and a satisfactory postsurgical aesthetic outcome; however, it is anatomically complicated and technically difficult. We introduce a simplified technique of Zabramski's orbitozygomatic craniotomy and present the anatomic and clinical findings with cadaveric photos, illustrations, and a video.


METHODS
The orbitozygomatic craniotomy was performed on 20 sides of 11 cadaveric heads, in which the cut between the inferior orbital fissure and superior orbital fissure was modified and simplified, and the shortest distance between them was measured. This technique was applied to 13 clinical cases, and craniotomy-associated aesthetic and functional complications were evaluated.


RESULTS
The average of the shortest distance from the inferior orbital fissure to superior orbital fissure was 21.3 mm (range, 19-23 mm) on the 20 sides of the 11 cadaveric heads. In all 13 clinical cases, orbitozygomatic craniotomy could be achieved in a short time, while preserving the structure of the orbital wall. A hollow at the temple was noted in 1 patient, cerebrospinal fluid leak occurred in 2 patients, and transient facial pain occurred in 1 patient; however, no other craniotomy-associated aesthetic or functional complications, including enophthalmos, were found in any of the 13 patients.


CONCLUSIONS
With this modified technique, Zabramski's ideal orbitozygomatic craniotomy could be achieved easily with only minimal complications, while realizing all advantages of the technique.
Department of Neurosurgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan. Electronic address: kode@u-fukui.ac.jp.
Toshiaki
T
Kodera
Department of Neurosurgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
Hidetaka
H
Arishima
Department of Neurosurgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
Shinsuke
S
Yamada
Department of Neurosurgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
Hiroshi
H
Arai
Department of Neurosurgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
Ayumi
A
Akazawa
Department of Neurosurgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
Yoshifumi
Y
Higashino
Department of Neurosurgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
Ryuhei
R
Kitai
Department of Anatomy, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
Satoshi
S
Iino
Center for Vascular Neurosurgery, International Neuroscience Institute Hannover, Hannover, Germany.
Helmut
H
Bertalanffy
Department of Neurosurgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
Ken-Ichiro
KI
Kikuta
D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000601:surgery; D002102:Cadaver; D003399:Craniotomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000601:surgery*; D019651:Plastic Surgery Procedures; D015050:Zygoma / Q000601:surgery*
Cadaveric dissection; Inferior orbital fissure; Orbital reconstruction; Orbitotomy; Orbitozygomatic approach; Superior orbital fissure