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Tamer Altay, Bhupendra C. K. Patel and William T. Couldwell

a challenging and unfamiliar place for many neurosurgeons. In the present study, we describe a novel surgical approach to access the cavernous sinus that involves the removal of the lateral orbital wall. This translateral orbital wall approach offers a quick, relatively easy, and less invasive access to the cavernous sinus with adequate exposure, obviating a formal craniotomy that is needed in previously described approaches. The approach also provides excellent cosmesis with a lateral orbital canthotomy skin incision. Methods Materials We performed 12

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Larry A. Sargent, Alan E. Seyfer and E. Neal Gunby

) , nasoethmoidal (center) , and naso-orbital (right) . In the nasofrontal encephalocele, the defect is between the frontal and nasal bones. Intracranially, the herniating dura passes through a defect in the frontoeth-moidal junction. As it projects forward it causes a downward displacement of the nasal bones and a lateral displacement of the medial orbital walls ( Fig. 1 left ). In the nasoethmoidal encephalocele, the defect is situated between the nasal bone and nasal cartilages, and the herniating dura passes through a defect between the frontal and ethmoidal bones

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Franco Demonte, Peyman Tabrizi, Scott A. Culpepper, Dima Suki, Charles N. S. Soparkar and James R. Patrinely

D uring resection of anterior and anterolateral skull base tumors it is not uncommon for the orbit to be entered. Oncologically sound removal of these tumors, the majority of which are malignant, typically requires resection of one or more of the osseous orbital walls. This may be necessary because of direct orbital involvement by the tumor leading to erosion of the orbital bones, or it may be planned to include a noninvolved margin of resection. Controversy exists regarding the timing, need for, and extent of orbital reconstruction after these partial orbital

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Jeffrey L. Marsh and Henry G. Schwartz

designed to insure prolonged suture patency and to limit the secondary manifestations of craniosynostosis. 9, 13 Our experience with these procedures, however, has revealed new problems: induction of an additional synostosis, midline forehead ridging, lateral orbital wall step-off, and palpable fixation wires. We report our modifications to overcome the untoward sequelae we have experienced with the Hoffman procedure for unilateral coronal synostosis 9 and the Marchac procedure for metopic synostosis. 13 Summary of Cases This series includes 21 consecutive cases

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Pakrit Jittapiromsak, Pushpa Deshmukh, Peter Nakaji, Robert F. Spetzler and Mark C. Preul

ethmoid air cells were removed until the medial orbital wall was defined. The anterior ethmoidal artery and nerve were identified passing through the anterior ethmoidal canal in the ethmoid cavity and then cut. This anterior ethmoidal complex stump served as a guide for tracing the ophthalmic artery and nasociliary nerve, intraorbitally. Posteriorly, the posterior ethmoid air cells and sphenoid sinus were explored as far as the medial optic canal. At this point, the posterior ethmoidal neurovascular complex was identified and cut. After ethmoid air cells were removed

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Joseph M. Zabramski, Talat Kiriş, Suresh K. Sankhla, Josep Cabiol and Robert F. Spetzler

orbital rim and zygoma prior to elevation of the temporal muscle. The access provided by elevation of the fascia over the zygomatic arch allows subperiosteal dissection along the orbital rim laterally and downward to the malar eminence ( Fig. 2 lower ). The skin flap is retracted inferiorly with fishhooks attached to the Leyla bar. Beginning at the lateral edge of the orbital rim, blunt dissection is used to free the periorbita gently from the lateral and superior aspects of the orbital walls. The dissection is made medially to the supraorbital nerve. If

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Yoshio Taguchi, Katsuyuki Tanaka, Motoshi Matsuzawa and Hiroaki Sekino

to a bone defect in the lateral compartment of the orbit and might have resulted in enophthalmos. However, no reconstruction of this part was made routinely. The incidence of postoperative enophthalmos was variable, 3, 11, 13, 14 but a large defect in the lateral orbital wall reportedly caused enophthalmos. 14 Our approach, reported elsewhere, 20 allowed en bloc removal of the superolateral wall of the orbit and caused no bone defect in the orbital walls. 20 The advantage of this approach is that it prevented postoperative enophthalmos, but it appeared to be

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Joost de Vries, Hans Peter M. Freihofer, Tomas Menovsky and Johannes R. M. Cruysberg

superolateral orbital wall and a protruding meningocele was successfully repaired without loss of visual function. Case Report History This 43-year-old woman first presented in 1975, when she was 22 years old, at the plastic surgery department with exophthalmos and vertical displacement of her right eye. This condition was not present at birth or during infancy, but became apparent during childhood. The exophthalmos was slowly progressing ( Fig. 1 ). The patient suffered from no physical complaints and there was no diplopia; however, she had self-acceptance problems

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Jan Boström, Gisela Janßen, Martina Messing-Jünger, Jörg U. Felsberg, Eva Neuen-Jacob, Volkher Engelbrecht, Hans-Gerd Lenard, Wolfgang J. Bock and Guido Reifenberger

became clinically apparent at the age of 4 years, with protrusion of his left eye due to an intraosseous xanthofibroma of the left orbital wall. Two years later, bilateral papilledema developed and the patient was found to have multiple intracranial space-occupying lesions. Three of these lesions were successively resected and histologically diagnosed as JXGs. We discuss the differential diagnosis of this rare disease manifestation. In addition, we review the current hypotheses concerning the origin and histiogenesis of JXG, as well as the therapeutic options for

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Robert S. Heller, Carlos A. David and Carl B. Heilman

remains some debate in the literature regarding the indications for and techniques to achieve orbital wall reconstruction following surgery on a patient with proptosis. The authors of some reported series argue that orbital wall reconstruction to prevent pulsatile enophthalmos is not necessary when the periorbita is intact. 3 , 7 Others series describe routine reconstruction of the orbital wall to prevent postoperative enophthalmos. 9 , 10 The philosophy at our institution has been to aggressively resect tumors with orbital invasion, including resection of the