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J Neurol Surg B Skull Base 2015; 76(06): 459-463
DOI: 10.1055/s-0035-1554903
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Modified One-piece Supraorbital Approach for Orbital Tumors: Widely Preserved Orbital Roof in a Self-fitting Flap

Satoru Shimizu
1   Department of Neurosurgery, Yokohama Stroke and Brain Center, Yokohama, Kanagawa, Japan
,
Shigeyuki Osawa
1   Department of Neurosurgery, Yokohama Stroke and Brain Center, Yokohama, Kanagawa, Japan
,
Tomoko Sekiguchi
1   Department of Neurosurgery, Yokohama Stroke and Brain Center, Yokohama, Kanagawa, Japan
,
Takahiro Mochizuki
1   Department of Neurosurgery, Yokohama Stroke and Brain Center, Yokohama, Kanagawa, Japan
,
Hidehiro Oka
2   Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
,
Toshihiro Kumabe
2   Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
› Author Affiliations
Further Information

Publication History

08 November 2014

30 March 2015

Publication Date:
15 June 2015 (online)

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Abstract

Objectives The one-piece supraorbital approach is a rational approach for the removal of orbital tumors. However, cutting the roof through the orbit is often difficult. We modified the technique to facilitate the osteotomy and improve the cosmetic effect.

Design Three burr holes are made: the first, the MacCarty keyhole (burr hole 1), exposes the anterior cranial fossa and orbit; the second is placed above the supraorbital nerve (burr hole 2); and the third on the superior temporal line. Through burr hole 2, a small hole is created on the roof, 10 mm in depth. Next the roof is rongeured through burr hole 1 toward the preexisting small hole. Seamless osteotomies using a diamond-coated threadwire saw and the preexisting four holes are performed. Lastly the flap is removed. On closure, sutures are passed through holes in the cuts made with the threadwire saw, and tied.

Results We applied our technique to address orbital tumors in two adult patients. The osteotomies in the roof were easy, and most parts of the roof were repositioned.

Conclusions Our modification results in orbital osteotomies with greater preservation of the roof. Because the self-fitting flap does not require the use of fixation devices, the reconstruction is cosmetically satisfactory.

Keywords

orbital roof - orbital tumor - osteotomy - supraorbital approach - threadwire saw
 

  • References

  • 1 Frazier CH. An approach to the hypophysis through the anterior cranial fossa. Ann Surg 1913; 57 (2) 145-150
    CrossrefPubMedGoogle Scholar
  • 2 Maroon JC, Kennerdell JS. Surgical approaches to the orbit. Indications and techniques. J Neurosurg 1984; 60 (6) 1226-1235
    CrossrefPubMedGoogle Scholar
  • 3 Jane JA, Park TS, Pobereskin LH, Winn HR, Butler AB. The supraorbital approach: technical note. Neurosurgery 1982; 11 (4) 537-542
    CrossrefPubMedGoogle Scholar
  • 4 MacCarty CS. The Surgical Treatment of Intracranial Meningiomas. Springfield, IL: Charles C Thomas; 1961: 57-60
    Google Scholar
  • 5 MacCarty CS. Surgical techniques for removal of intracranial meningiomas. Clin Neurosurg 1961; 7: 100-111
    PubMedGoogle Scholar
  • 6 MacCarty CS, Brown DN. Orbital tumors in children. Clin Neurosurg 1964; 11: 76-88
    PubMedGoogle Scholar
  • 7 Shimizu S, Tanriover N, Rhoton Jr AL, Yoshioka N, Fujii K. MacCarty keyhole and inferior orbital fissure in orbitozygomatic craniotomy. Neurosurgery 2005; 57 (1, Suppl): 152-158 ; discussion 158–159
    CrossrefPubMedGoogle Scholar
  • 8 Shimizu S, Kondo K, Yamazaki T, Nakayama K, Yamamoto I, Fujii K. Repositioning of cranial bone flaps cut with a diamond-coated threadwire saw: 5-year experience with cosmetic cranioplasty without fixation devices. Skull Base 2011; 21 (5) 323-328
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Lemole Jr GM, Henn JS, Zabramski JM, Spetzler RF. Modifications to the orbitozygomatic approach. Technical note. J Neurosurg 2003; 99 (5) 924-930
    CrossrefPubMedGoogle Scholar
  • 10 Seçkin H, Avci E, Uluç K, Niemann D, Başkaya MK. The work horse of skull base surgery: orbitozygomatic approach. Technique, modifications, and applications. Neurosurg Focus 2008; 25 (6) E4
    CrossrefPubMedGoogle Scholar
  • 11 Delashaw Jr JB, Jane JA, Kassell NF, Luce C. Supraorbital craniotomy by fracture of the anterior orbital roof. Technical note. J Neurosurg 1993; 79 (4) 615-618
    CrossrefPubMedGoogle Scholar
  • 12 Aziz KMA, Froelich SC, Cohen PL, Sanan A, Keller JT, van Loveren HR. The one-piece orbitozygomatic approach: the MacCarty burr hole and the inferior orbital fissure as keys to technique and application. Acta Neurochir (Wien) 2002; 144 (1) 15-24
    CrossrefPubMedGoogle Scholar
  • 13 Hayashi N, Hirashima Y, Kurimoto M, Asahi T, Tomita T, Endo S. One-piece pedunculated frontotemporal orbitozygomatic craniotomy by creation of a subperiosteal tunnel beneath the temporal muscle: technical note. Neurosurgery 2002; 51 (6) 1520-1523 ; discussion 1523–1524
    CrossrefPubMedGoogle Scholar
  • 14 Balasingam V, Noguchi A, McMenomey SO, Delashaw Jr JB. Modified osteoplastic orbitozygomatic craniotomy. Technical note. J Neurosurg 2005; 102 (5) 940-944
    CrossrefPubMedGoogle Scholar
  • 15 Tanriover N, Ulm AJ, Rhoton Jr AL, Kawashima M, Yoshioka N, Lewis SB. One-piece versus two-piece orbitozygomatic craniotomy: quantitative and qualitative considerations. Neurosurgery 2006; 58 (4) (Suppl. 02) ONS-229-ONS-237 ; discussion ONS-237
    PubMedGoogle Scholar
  • 16 Winston KR, Wang MC. Cranial bone fixation: review of the literature and description of a new procedure. J Neurosurg 2003; 99 (3) 484-488
    CrossrefPubMedGoogle Scholar
  • 17 Iwama T, Yamada J, Imai S, Shinoda J, Funakoshi T, Sakai N. The use of frozen autogenous bone flaps in delayed cranioplasty revisited. Neurosurgery 2003; 52 (3) 591-596 ; discussion 595–596
    PubMedGoogle Scholar