Advanced Cranial Approaches

One piece fronto-orbito-zygomatic approach

01. Interfascial dissection
Right-sided fronto-orbitozygomatic approach. Interfascial dissection exposing the deep temporalis fascia.
02. Zygomatic arch exposure
After interfascial dissection the zygomatic arch is exposed by subperiosteal dissection in order to protect the frontal branch of the facial nerve.
03. Temporalis muscle mobilization
The temporalis muscle is fully mobilised.
04. FTOZ bone cuts simulation
First, the sphenoid ridge keyhole is drilled exposing the frontal and temporal dura and the periorbita. Next, the sequential steps of the bone cuts needed to do one piece full fronto-orbito zygomatic approach are marked with different colors.
05. FTOZ bone flap
06. Dura exposure
07. Cavernous sinus exposure
The meningo-orbital band is divided (the technique is presented in separate images) and the lateral wall of the cavernous sinus is exposed presenting the Gasserian ganglion, V1, V2 and V3.
08. Anterior clinoidectomy
Anterior clinoidectomy was done first by unroofing the optic canal and then by hollowing out the anterior clinoid process and removing the optic strut.
09. Anterior petrosectomy through FTOZ exposure
Anterior petrosectomy approach through FTOZ exposure. The petrous apex was drilled and the internal acoustic canal was exposed. The cisternal, meatal and tympanic segments of the facial nerve are presented.