Departments of1Neurosurgery and.
2Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin.
Neurosurg Focus. 2024 Apr;56(4):E11. doi: 10.3171/2024.1.FOCUS23875.
The authors aim to describe the advantages, utility, and disadvantages of the transpalpebral mini-orbitozygomatic (MOZ) approach for tumors of the lateral and superior orbit, orbital apex, anterior clinoid, anterior cranial fossa, middle cranial fossa, and parasellar region.
The surgical approach from skin incision to closure is described while highlighting key technical and anatomical considerations, and cadaveric dissection demonstrates the surgical steps and focuses on important anatomy. Intraoperative images were included to supplement the cadaveric dissection. A retrospective review of adults who had undergone the MOZ approach for nonvascular pathology performed by a single neurosurgeon from 2017 to 2023 was included in this institutional review board-approved study. Descriptive statistics was used to summarize the data. Four representative cases were included to demonstrate the utility of the MOZ approach.
The study included 65 patients (46 female, 19 male), average age 54.84 years, who had undergone transpalpebral MOZ surgery. Presenting symptoms included visual changes (53.8% of cases), vision loss (23.1%), diplopia (21.8%), and proptosis (13.8%). The optic nerve and optic chiasm were involved in 32.3% and 10.8% of cases, respectively. The most common pathology was meningioma (81.5% of cases), and gross-total resection was achieved in 50% of all cases. Major complications included an infection and a carotid injury. Improvement of preoperative symptoms was reported in 92.2% of cases. Visual acuity improved in 12 patients. The mean follow-up was 8.57 ± 8.45 months.
The MOZ approach is safe and durable. The transpalpebral incision provides better cosmesis and functional outcomes than those of standard anterolateral approaches to the skull base. Careful consideration of the limits of the approach is paramount to appropriate application on a case-by-case basis. Further quantitative anatomical studies can help to define and compare the utility of the approach to open cranio-orbital and endoscopic transorbital approaches.
作者旨在描述经眼睑小眶颧（MOZ）入路治疗外侧和上部眼眶、眶尖、前床突、前颅窝、中颅窝和鞍旁区域肿瘤的优势、实用性和缺点。
描述了从皮肤切口到闭合的手术入路，同时强调了关键的技术和解剖学考虑因素，并进行了尸体解剖演示，重点介绍了手术步骤和重要解剖结构。术中图像也被包括在内，以补充尸体解剖。本机构审查委员会批准的研究纳入了 2017 年至 2023 年期间由一位神经外科医生对患有非血管性病变的成年人进行的 MOZ 入路回顾性研究。使用描述性统计数据总结数据。纳入了 4 个代表性病例，以展示 MOZ 入路的实用性。
研究纳入了 65 例患者（46 例女性，19 例男性），平均年龄 54.84 岁，接受了经眼睑 MOZ 手术。主要症状包括视力改变（53.8%的病例）、视力丧失（23.1%）、复视（21.8%）和眼球突出（13.8%）。视神经和视交叉受累分别占 32.3%和 10.8%。最常见的病变是脑膜瘤（81.5%的病例），所有病例中有 50%实现了大体全切除。主要并发症包括感染和颈动脉损伤。92.2%的病例报告术前症状改善。12 例患者视力提高。平均随访时间为 8.57 ± 8.45 个月。
MOZ 入路是安全且持久的。与标准的颅底前外侧入路相比，经眼睑切口提供了更好的美容效果和功能结果。在逐例应用时，仔细考虑手术入路的局限性至关重要。进一步的定量解剖学研究可以帮助定义和比较该入路与开颅眶入路和内镜经眶入路的实用性。
