widening of the ETOA entry site through lateral orbital rim (LOR) osteotomy has tremendous advantages in endoscopic surgery. 9 Due to the nature of endoscopic surgery, even if the entry site is only slightly wider, the angle to the target and surgical freedom of operation are significantly increased. Surgical freedom and angle of attack of horizontal movement can be obtained via an ETOA with LOR osteotomy, but vertical movement is limited in the conventional ETOA. Due to this vertical movement limitation, some lesions of the anterior cranial fossa are difficult to
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*Jaejoon Lim, Kyoung Su Sung, Woohyun Kim, Jihwan Yoo, In-Ho Jung, Seonah Choi, Seung Hoon Lim, Tae Hoon Roh, Chang-Ki Hong, and Ju Hyung Moon
Kost Elisevich, Larry Allen, Uldis Bite, and Robert Colcleugh
and lateral margins bilaterally and to allow stripping of the periorbita from the walls. The supraorbital nerve and artery are easily preserved within the reflected tissue, although at times a small osteotomy is necessary to mobilize the neurovascular bundle from the osseous margin. The temporal fascia and muscle are stripped anterosuperiorly and along the anterior margin of attachment sufficiently to allow exposure of the lateral orbital rim and placement of a burr hole immediately behind the orbital process of the frontal bone below the superior temporal line
John A. Persing, John A. Jane, T. S. Park, Milton T. Edgerton, and Johnny B. Delashaw
S kulls deformed by metopic, unilateral, or bilateral coronal synostosis result in diminished projection of the supralateral orbital rim. 1, 5–13 In addition, individuals with coronal and to a lesser extent metopic synostosis have reduced anteroposterior projection of the zygoma ( Fig. 1 ). Although many methods have been described to correct the orbital rim abnormalities, the lateral canthal advancement technique is presently the most widely practiced. 7 There are two problems with this technique, however. First, with this procedure, the advancement of the
Kost Elisevich, Uldis Bite, and Robert G. Colcleugh
age. The horizontal advancement techniques of Tessier, 22 later refined and altered by numerous authors, 1, 5, 6, 9, 14, 20 provided consistently better cosmetic results. In the midst of these operative refinements, however, problems persisted in the older pediatric population; these included lateral orbital wall step-off, malar hypoplasia, resorption of interposed osseous struts with collapse, inadequate fixation, and palpable fixation hardware. We have applied a means of advancing the orbital rim and zygoma in cases of unilateral coronal synostosis which is
Marc S. Schwartz, Gregory J. Anderson, Michael A. Horgan, Jordi X. Kellogg, Sean O. McMenomey, and Johnny B. Delashaw Jr.
M uch attention in the neurosurgical literature has been focused on the use of orbitozygomatic osteotomy to facilitate exposure along the base of the brain. Although the traditional techniques of frontal, temporal, and pterional craniotomy are adequate for reaching many lesions located in the regions of the interpeduncular fossa, clivus, and cavernous sinus, newer methods involving disarticulation of the orbital rim and zygomatic arch have increasingly been used. 6, 7, 11, 12, 16, 26 The goal of these surgical adjuncts has been to improve exposure areas and to
Anthony J. Raimondi and Francisco A. Gutierrez
of the orbital rim. Because of the rapid growth of bone across the craniectomy, the use of foreign materials along the edges of the linear craniectomy has been recommended to retard the regrowth of the bone. These have included tantalum foil, advocated by Simmons and Peyton in 1947, 12 followed 2 years later by the use of polyethylene by Ingraham, et al., 5 and the application of Zenker's acidic fixative solution 9 recommended by Anderson and Johnson. 2 Recent techniques include rotation of the frontal bone flap, thus remodeling the cranial vault, obtaining
Joseph Nadell and David G. Kline
) and frontal-basal (33 cases). Frontal-basal fractures were associated with damage to the cribriform plate, frontal or ethmoidal sinuses, and orbital rim; frontal-vault fractures were those without associated cranial or sinus injuries. The frontal-basal group included 25 fractures of the cribriform plate, 13 of the orbital rim, and 19 involving frontal or frontal and ethmoid sinuses. Compound fractures predominated in our series of frontal fractures (80%). Table 1 correlates the incidence of dural and underlying brain injury with different fracture sites. Compound
John A. Jane, T. S. Park, Barry M. Zide, Phillip Lambruschi, John A. Persing, and Milton T. Edgerton
itself. A surgical procedure to correct this condition probably should include a remolding of the contralateral frontal bone as well as the ipsilateral orbital rim. C: Most extreme form of coronal synostosis in which the contralateral bulge is severe and the ipsilateral thickening is marked. In these cases the contralateral frontal bone should be corrected as well as the ipsilateral temporal deformity. This report presents our understanding of the clinical and pathological entity of unilateral coronal synostosis. Operative correction should be technically simple
Modified osteoplastic orbitozygomatic craniotomy
Technical note
Vijayabalan Balasingam, Akio Noguchi, Sean O. McMenomey, and Johnny B. Delashaw Jr.
one-piece osteoplastic bone flap that incorporates the frontal, temporal, and lateral portions of the orbital rim as a technically simpler alternative. The orbital rim component extends from just lateral to the supraorbital foramen/notch to the frontozygomatic suture. The osteoplastic bone flap minimally obstructs the surgical view and provides the advantages of the standard OZ exposure. Use of this technique avoids temporal hollowing from temporalis muscle atrophy or slumping while maintaining vascularization of the one-piece bone flap together with a decreased
Raywat Noiphithak, Juan C. Yanez-Siller, Juan Manuel Revuelta Barbero, Bradley A. Otto, Ricardo L. Carrau, and Daniel M. Prevedello
instruments, particularly due to the improved illumination and panoramic visualization of the endoscope. The transorbital endoscopic approach (TOEA) has caught the attention of many and is rapidly being incorporated into the skull base treatment armamentarium. Recently, an increasing number of studies have demonstrated the adequacy of TOEA for providing safe and satisfying access to critical skull base regions. 24 Notwithstanding, this approach has consistently been subject to modifications. Some investigators favor the preservation of the lateral orbital rim (LOR
