Clinical Application of the Orbitozygomatic Approach in Cerebrovascular Surgery

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The orbitozygomatic approach is a modification of the basic pterional approach, providing wide, multidirectional access to the critical medial structures. Complete removal of the orbitozygomatic bar increases the angle of exposure and decreases the working depth. The authors describe technical details and application in cerebrovascular surgery. During the past 2 years, this approach was used in 2.4% (7/290) of patients who underwent aneurysm or arteriovenous malformation (AVM) surgery in our department. All patients had surgically challenging lesions including coil inaccessible basilar apex/high-positioned BA-SCA aneurysms and a high-grade mesial temporal AVM. The lesions were successfully obliterated with acceptable surgical morbidity (14.2% ; 1/7) . This approach will continue to play a significant role in cerebrovascular surgery in the endovascular era.