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Review
. 2022 Mar 21;92(S4):e2021350.
doi: 10.23750/abm.v92iS4.12784.

Cranio-Orbito-Zygomatic Approach

Sabino Luzzi  1 , Alice Giotta Lucifero  2 , Nunzio Bruno  3 , Matias Baldoncini  4 , Alvaro Campero  5 , Renato Galzio  6
Affiliations
Review

Cranio-Orbito-Zygomatic Approach

Sabino Luzzi et al. Acta Biomed. .

Abstract

The cranio-orbito-zygomatic (COZ) approach consists of an extension of the pterional approach characterized by the removal of the superolateral part of the orbital rim and zygoma. This key step tremendously increases the angular exposure to some deep targets and overall surgical freedom to the lesion. In this article we review the technical variations of the COZ approach, mainly focusing on the differential quantitative effects coming from the orbital osteotomy compared to the zygomatic one.

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Figures

Figure 1.
Figure 1.. (a) position and skin incision. (b-d) galea-pericranium vascularized flap and subfascial dissection of the superficial temporal fascia. (e-g) retrograde subperiosteal dissection of the temporalis muscle according to the Oikawa technique and the skeletonization of the orbito-pterional region.
Figure 2.
Figure 2.. Comparison between pterional (a) approach and one-piece (b), two-piece (c,d), and three-piece COZ craniotomy with the relative surgical steps (f-l). Comparison in the surgical exposure between the pterional (m) vs O-pt approach (n) and pterional (o) and transzygomatic (p) approach.
Figure 3.
Figure 3.. Preoperative digital subtraction angiography of the right vertebral artery in anterior-posterior (a) and lateral (b) projection. (c,d) Intraoperative pictures showing the right optic-carotid (1), carotid-oculomotor (2), supra-carotid (3), and oculomotor-tentorial (4) deep windows. Exposure (e) and clip ligation (f) of the basilar tip aneurysm. (g) 3D volume-rendered post-operative CT scan highlighting the COZ approach. (h) Postoperative digital subtraction angiography of the right vertebral artery in lateral projection
Figure 4.
Figure 4.. (a-e) 3D volume-rendered preoperative CT angiography. Intraoperative pictures were taken before (f) and after (g) the clipping of the aneurysm. (h) Post-clipping indocyanine green videoangiography. (i) 3D volume-rendered postoperative CT scan showing the orbito-pterional approach. (l) Digital subtraction angiography of the right internal carotid artery in anterior-posterior projection. (m) Postoperative 3D volume-rendered CT angiography.
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References

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