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Intraorbital Meningioma: Orbitozygomatic Craniotomy

July 01, 2015

Transcript

Here is another video for resection of an intraorbital tumor using Orbitozygomatic Craniotomy. This is a 50-year-old male with right-sided visual dysfunction on proptosis. Imaging revealed erode to the homogeneously enhancing mass along the mid to posterior compartment of the orbit associated with high proptosis. You can see the proptosis on MRI as well. CT scan also confirmed the hypostasis along the lateral wall of the orbit, due to location of the mass patient underwent right-sided Orbitozygomatic Craniotomy, you can see the scalp flap is reflected anteriorly in a separate layer from a temporalis muscle. The fat pad is also mobilized using the subfascial technique. The frontal process of zygoma was palpated. You can see the direction of disconnection of the superficial as well as deep temporalis fascia along with a fat pad. The orbital rim is also exposed. Next the temporalis muscle is disconnected from the superior temporal line. A cuff muscle and fascia, are left behind for later closure. The keyhole is generously exposed, as supraorbital nerve is reflected anteriorly out of its groove and the preorbital underneath the rim of the orbit is dissected away from the roof of the orbit. Here's the front side nomadic suture, a bear hole, a keyhole is created a few millimeter above and posterior to this suture. Drilling is conducted at 45 degrees to the surface of the skull to avoid entry into the, and through cranial base without opening up the preorbital. Careful completion of the keyhole is important for precise performance of the one piece modified Orbitozygomatic Craniotomy. You can see the preorbital, the roof of the orbit and the frontal dura. All three elements should be exposed through the keyhole. Another bear hole is placed more posteriorly just inferior to the posterior aspect of the superior temporal line. The dura is generously stripped away from underneath the calvarium. The initial osteotomy starts from the posterior bare hole arches anteriorly, and it stops at the level of the orbital rim. The big one without a foot plate is used to perform an osteotomy at the level of the rim. The frontal sinus is avoided if possible. Next and other bony cut is completed on the temporal side, stopping short of this vineyard wink. The dura is turned upon itself and removed and other osteotomy should be completed below the frontal zygomatic suture disconnecting the frontal process of zygoma. The periobita is protected during drilling. This osteotomy connects to the other osteotomy at the level of the terrier. Cotton patties are a placed near the keyhole to protect the preorbital and the frontal dura small osteotome disconnects the roof of the orbit The osteotomy is angled toward the cut at the level of the orbital rim. The one piece bone flap is elevated, and a lateral sphenoid wing is resected. Can see the preorbital Lumbar drain was installed at the beginning of the procedure for brain relaxation. You can see the superior orbital fissure. An extradural clinoidectomy is also pursued to decompress the optic nerve. Here's the optic nerve and it's encasing dura, the nervous generously decompressed so that the nerve is not inadvertently injured, during manipulation of the tumor and its removal. Preorbital is entered, and the intro orbital component of the tumor is removed. Gentle palpation can be quite effective for localizing where the tumor reaches closest to the surface of the preorbital. Standard techniques are used for tumor debulking and resection. The base of the tumor and area of the eye prosthesis are also removed. Some of the air cells around the clinoid process are also sealed off during the closure since significant amount of their lateral, as well as the superior or the roof of the orbit were removed every construction procedure was conducted, to minimize the risk of post operative endo thalamus. The bone flap was next replaced, and the closure was completed in standard fashion. Thank you.

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