Frontotemporal-Orbitozygomatic Approach and Its Variants: Technical Nuances and Video Illustration

Abstract

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.