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颅眶颧入路：定制目标暴露和手术自由度的核心技术。

Cranio-Orbito-Zygomatic Approach: Core Techniques for Tailoring Target Exposure and Surgical Freedom.

作者信息

Luzzi Sabino, Giotta Lucifero Alice, Spina Alfio, Baldoncini Matías, Campero Alvaro, Elbabaa Samer K, Galzio Renato

机构信息

Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy.

Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy.

出版信息

Brain Sci. 2022 Mar 18;12(3):405. doi: 10.3390/brainsci12030405.

DOI:10.3390/brainsci12030405
PMID:35326360
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8946068/
Abstract

BACKGROUND

The cranio-orbito-zygomatic (COZ) approach is a workhorse of skull base surgery, and each of its steps has a precise effect on target exposure and surgical freedom. The present study overviews the key techniques for execution and tailoring of the COZ approach, focusing on the quantitative effects resulting from removal of the orbitozygomatic (OZ) bar, orbital rim, and zygomatic arch.

METHODS

A PRISMA-based literature review was performed on the PubMed/Medline and Web of Science databases using the main keywords associated with the COZ approach. Articles in English without temporal restriction were included. Eligibility was limited to neurosurgical relevance.

RESULTS

A total of 78 articles were selected. The range of variants of the COZ approach involves a one-piece, two-piece, and three-piece technique, with a decreasing level of complexity and risk of complications. The two-piece technique includes an OZ and orbitopterional variant. Superolateral orbitotomy expands the subfrontal and transsylvian corridors, increasing surgical freedom to the basal forebrain, hypothalamic region, interpeduncular fossa, and basilar apex. Zygomatic osteotomy shortens the working distance of the pretemporal and subtemporal routes.

CONCLUSION

Subtraction of the OZ bar causes a tremendous increase in angular exposure of the subfrontal, transsylvian, pretemporal, and subtemporal perspectives avoiding brain retraction, allowing for multiangled trajectories, and shortening the working distance. The COZ approach can be tailored based on the location of the lesion, thus optimizing the target exposure and surgical freedom and decreasing the risk of complications.

摘要

背景

颅眶颧（COZ）入路是颅底手术的常用方法，其每一步骤对目标暴露和手术操作空间都有精确影响。本研究概述了COZ入路的实施和调整的关键技术，重点关注去除眶颧（OZ）杆、眶缘和颧弓所产生的量化影响。

方法

在PubMed/Medline和Web of Science数据库上进行基于PRISMA的文献综述，使用与COZ入路相关的主要关键词。纳入无时间限制的英文文章。纳入标准限于神经外科相关性。

结果

共筛选出78篇文章。COZ入路的变体范围包括一体式、两件式和三件式技术，其复杂性和并发症风险依次降低。两件式技术包括OZ和眶翼点变体。眶上外侧开颅术扩大了额下和经侧裂通道，增加了到达基底前脑、下丘脑区域、脚间窝和基底动脉尖的手术操作空间。颧骨截骨术缩短了颞前和颞下路径的工作距离。

结论

去除OZ杆可显著增加额下、经侧裂、颞前和颞下视角的角度暴露，避免脑牵拉，允许多角度手术路径，并缩短工作距离。COZ入路可根据病变位置进行调整，从而优化目标暴露和手术操作空间，并降低并发症风险。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/682b/8946068/1b523be2dd1b/brainsci-12-00405-g010.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/682b/8946068/991dc6581eba/brainsci-12-00405-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/682b/8946068/a2b29f9a6cda/brainsci-12-00405-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/682b/8946068/0535ae3f66ab/brainsci-12-00405-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/682b/8946068/e3564dff5296/brainsci-12-00405-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/682b/8946068/11af0d2e128d/brainsci-12-00405-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/682b/8946068/c03974e5b4af/brainsci-12-00405-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/682b/8946068/7e37921eb3dd/brainsci-12-00405-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/682b/8946068/17156eaabd56/brainsci-12-00405-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/682b/8946068/047a91a3c855/brainsci-12-00405-g009.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/682b/8946068/1b523be2dd1b/brainsci-12-00405-g010.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/682b/8946068/991dc6581eba/brainsci-12-00405-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/682b/8946068/a2b29f9a6cda/brainsci-12-00405-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/682b/8946068/0535ae3f66ab/brainsci-12-00405-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/682b/8946068/e3564dff5296/brainsci-12-00405-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/682b/8946068/11af0d2e128d/brainsci-12-00405-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/682b/8946068/c03974e5b4af/brainsci-12-00405-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/682b/8946068/7e37921eb3dd/brainsci-12-00405-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/682b/8946068/17156eaabd56/brainsci-12-00405-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/682b/8946068/047a91a3c855/brainsci-12-00405-g009.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/682b/8946068/1b523be2dd1b/brainsci-12-00405-g010.jpg

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