Browsing by Author "Fernandez-Miranda, Juan C."

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    Endoscopic Anatomy of the Zygomatic Nerve: Implications for the Endoscopic Transmaxillary Approach
    (Thieme, 2021-12-14) Xu, Yuanzhi; Nunez, Maximiliano Alberto; Mohyeldin, Ahmed; Fernandez-Miranda, Juan C.; Cohen-Gadol, Aaron A.; Neurological Surgery, School of Medicine
    Introduction: Understanding the anatomic features of the zygomatic nerve is critical for performing the endoscopic transmaxillary approach properly. Injury to the zygomatic nerve can result in facial numbness and corneal problems. Objective: To evaluate the surgical anatomy of the zygomatic nerve and its segments from an endoscopic endonasal perspective for clinical implications of performing the endoscopic transmaxillary approach. Methods: The origin, course, length, and segments of the zygomatic nerve were studied in four specimens from an endonasal perspective. Results: The zygomatic nerve arises 4.1 ± 1.7 mm from the foramen rotundum of the maxillary nerve in the superolateral pterygopalatine fossa (PPF). According to its anatomic region in endonasal endoscopic surgery, we divided the zygomatic nerve into two segments: the PPF segment, from origin to the point of entry under Muller's muscle, which runs superolaterally to the inferior orbital fissure (IOF) (length, 4.6 ± 1.3 mm), and the IOF segment, starting at the entry point in Muller's muscle and terminating at the exit point in the IOF, which travels between Muller's muscle and the great wing of the sphenoid bone (length, 19.6 ± 3.6 mm). In the transmaxillary approach, the zygomatic nerve is a critical landmark in the superolateral PPF. Conclusion  The zygomatic nerve travels in the PPF and the IOF; better visualization and preservation of this nerve during endonasal endoscopic surgery are crucial for successful outcomes.
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    Frontotemporal-Orbitozygomatic Approach and Its Variants: Technical Nuances and Video Illustration
    (Wolters Kluwer, 2022-12) El Ahmadieh, Tarek Y.; Nuñez, Maximiliano; Vigo, Vera; Abou-Al-Shaar, Hussam; Fernandez-Miranda, Juan C.; Cohen-Gadol, Aaron A.; Neurological Surgery, School of Medicine
    The frontotemporal-orbitozygomatic (FTOz) approach is an extension of the traditional pterional approach. It provides the neurosurgeon with a wide access to the skull base with minimal or no brain retraction needed; it also offers a panoramic view that enables various trajectories toward the anterior, middle, and central cranial fossae as well as the upper segment of the posterior cranial fossa. Intracranial lesions that can be addressed using the FTOz approach include large medial sphenoid wing and spheno-orbital meningiomas; suprasellar and parasellar tumors; lesions of the orbital apex, interpeduncular cistern, third ventricle, and upper paraclival regions; and anterior communicating artery and basilar-tip aneurysms. In this article, we discuss the advantages and disadvantages of the FTOz approach and describe related technical nuances and common pitfalls. Our goal was to provide an up-to-date report of this time-tested surgical approach using original high-quality dissections, 3-dimensional models, and 2-dimensional 4K videos to serve as a reliable and practical educational resource for neurosurgery trainees and junior neurosurgeons. A case example is also provided to show the 1-piece orbitozygomatic approach.