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Safe fronto-orbito-zygomatic osteotomy using a diamond-coated threadwire saw in orbito-zygomatic craniotomy.

Wada K, Mori K, Toyooka T, Otani N, Fujii K, Ueno H, Tomura S, Tomiyama A - Asian J Neurosurg (2015 Jul-Sep)

Bottom Line: This method was applied to the treatment of four patients with skull-based tumors or internal carotid and basilar artery aneurysms.Postoperative three-dimensional bone density computed tomography showed minimum bone gap in the ME.No craniotomy-related complication has occurred.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan.

ABSTRACT
Orbito-zygomatic craniotomy is a widely accepted skull-based technique, but osteotomy at the malar eminence (ME) is complicated. We have developed a safe fronto-orbito-zygomatic (FOZ) osteotomy by creating small guide burr holes in the superior and lateral parts of the orbital wall and cutting the bone using a diamond-coated threadwire saw. This method involves standard two-piece osteotomy by creating small superior and lateral guide orbital burr holes instead of sectioning into the superior and inferior orbital fissures. The guide burr holes are connected using a diamond-coated threadwire saw to create the FOZ bar. This method was applied to the treatment of four patients with skull-based tumors or internal carotid and basilar artery aneurysms. Postoperative three-dimensional bone density computed tomography showed minimum bone gap in the ME. No craniotomy-related complication has occurred. FOZ osteotomy by creating guide burr holes in the orbital wall and cutting the bone using a diamond-coated threadwire saw is safe and results in minimum bone gap in the ME.

No MeSH data available.


Related in: MedlinePlus

Photographs of the three-dimensional skull model showing the process of fronto-orbito-zygomatic bar formation using a diamond-coated threadwire saw. (a) Outer sheath is passed between the periorbita and superior orbital burr hole. (b) Bone cutting using a diamond-coated threadwire saw passing from the lateral orbital burr hole to the zygoma to cut the malar eminence. Arrowhead: Infratemporal crest
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Figure 2: Photographs of the three-dimensional skull model showing the process of fronto-orbito-zygomatic bar formation using a diamond-coated threadwire saw. (a) Outer sheath is passed between the periorbita and superior orbital burr hole. (b) Bone cutting using a diamond-coated threadwire saw passing from the lateral orbital burr hole to the zygoma to cut the malar eminence. Arrowhead: Infratemporal crest

Mentions: Figure 1 illustrates the difference in the bone cutting lines between the standard FOZ osteotomy sectioning into the SOF to IOF, and FOZ bone cutting with superior and lateral orbital small guide burr holes. The diamond T-saw (0.64 mm diameter) within the outer sheath is passed from the medial orbit to the superior orbital burr hole [Figure 2a]. A tapered brain spatula is placed between the periorbita and the orbit to protect the periorbita. The outer sheath is then removed, both ends of the wire are grasped with Péan forceps, and reciprocal movement of the saw is made to cut the orbital roof. The wire saw is then passed from the superior orbital burr hole to the inferior burr hole, and the lateral wall of the orbit is cut, in the same way. The wire saw is then passed from the lateral part of the orbit to the lateral orbital burr hole, and under the zygomatic arch near the ME. The reciprocal wire saw movement automatically cuts the ME [Figure 2b]. Finally, the zygomatic arch near the root of the zygoma is cut. Consequently, the FOZ bar is created without fracture and with minimum bone loss. Additional removal of the orbital roof and opening of the SOF and optic canal can be added according to the pathology if necessary.


Safe fronto-orbito-zygomatic osteotomy using a diamond-coated threadwire saw in orbito-zygomatic craniotomy.

Wada K, Mori K, Toyooka T, Otani N, Fujii K, Ueno H, Tomura S, Tomiyama A - Asian J Neurosurg (2015 Jul-Sep)

Photographs of the three-dimensional skull model showing the process of fronto-orbito-zygomatic bar formation using a diamond-coated threadwire saw. (a) Outer sheath is passed between the periorbita and superior orbital burr hole. (b) Bone cutting using a diamond-coated threadwire saw passing from the lateral orbital burr hole to the zygoma to cut the malar eminence. Arrowhead: Infratemporal crest
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4553746&req=5

Figure 2: Photographs of the three-dimensional skull model showing the process of fronto-orbito-zygomatic bar formation using a diamond-coated threadwire saw. (a) Outer sheath is passed between the periorbita and superior orbital burr hole. (b) Bone cutting using a diamond-coated threadwire saw passing from the lateral orbital burr hole to the zygoma to cut the malar eminence. Arrowhead: Infratemporal crest
Mentions: Figure 1 illustrates the difference in the bone cutting lines between the standard FOZ osteotomy sectioning into the SOF to IOF, and FOZ bone cutting with superior and lateral orbital small guide burr holes. The diamond T-saw (0.64 mm diameter) within the outer sheath is passed from the medial orbit to the superior orbital burr hole [Figure 2a]. A tapered brain spatula is placed between the periorbita and the orbit to protect the periorbita. The outer sheath is then removed, both ends of the wire are grasped with Péan forceps, and reciprocal movement of the saw is made to cut the orbital roof. The wire saw is then passed from the superior orbital burr hole to the inferior burr hole, and the lateral wall of the orbit is cut, in the same way. The wire saw is then passed from the lateral part of the orbit to the lateral orbital burr hole, and under the zygomatic arch near the ME. The reciprocal wire saw movement automatically cuts the ME [Figure 2b]. Finally, the zygomatic arch near the root of the zygoma is cut. Consequently, the FOZ bar is created without fracture and with minimum bone loss. Additional removal of the orbital roof and opening of the SOF and optic canal can be added according to the pathology if necessary.

Bottom Line: This method was applied to the treatment of four patients with skull-based tumors or internal carotid and basilar artery aneurysms.Postoperative three-dimensional bone density computed tomography showed minimum bone gap in the ME.No craniotomy-related complication has occurred.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan.

ABSTRACT
Orbito-zygomatic craniotomy is a widely accepted skull-based technique, but osteotomy at the malar eminence (ME) is complicated. We have developed a safe fronto-orbito-zygomatic (FOZ) osteotomy by creating small guide burr holes in the superior and lateral parts of the orbital wall and cutting the bone using a diamond-coated threadwire saw. This method involves standard two-piece osteotomy by creating small superior and lateral guide orbital burr holes instead of sectioning into the superior and inferior orbital fissures. The guide burr holes are connected using a diamond-coated threadwire saw to create the FOZ bar. This method was applied to the treatment of four patients with skull-based tumors or internal carotid and basilar artery aneurysms. Postoperative three-dimensional bone density computed tomography showed minimum bone gap in the ME. No craniotomy-related complication has occurred. FOZ osteotomy by creating guide burr holes in the orbital wall and cutting the bone using a diamond-coated threadwire saw is safe and results in minimum bone gap in the ME.

No MeSH data available.


Related in: MedlinePlus