Modified One-piece Supraorbital Approach for Orbital Tumors: Widely Preserved Orbital Roof in a Self-fitting Flap |
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Authors: | Satoru Shimizu Shigeyuki Osawa Tomoko Sekiguchi Takahiro Mochizuki Hidehiro Oka Toshihiro Kumabe |
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Institution: | 1.Department of Neurosurgery, Yokohama Stroke and Brain Center, Yokohama, Kanagawa, Japan;2.Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan |
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Abstract: | Objectives The one-piece supraorbital approach is a rational approach for the removal of orbital tumors. However, cutting the roof through the orbit is often difficult. We modified the technique to facilitate the osteotomy and improve the cosmetic effect.
Design Three burr holes are made: the first, the MacCarty keyhole (burr hole 1), exposes the anterior cranial fossa and orbit; the second is placed above the supraorbital nerve (burr hole 2); and the third on the superior temporal line. Through burr hole 2, a small hole is created on the roof, 10 mm in depth. Next the roof is rongeured through burr hole 1 toward the preexisting small hole. Seamless osteotomies using a diamond-coated threadwire saw and the preexisting four holes are performed. Lastly the flap is removed. On closure, sutures are passed through holes in the cuts made with the threadwire saw, and tied.
Results We applied our technique to address orbital tumors in two adult patients. The osteotomies in the roof were easy, and most parts of the roof were repositioned.
Conclusions Our modification results in orbital osteotomies with greater preservation of the roof. Because the self-fitting flap does not require the use of fixation devices, the reconstruction is cosmetically satisfactory. |
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Keywords: | orbital roof orbital tumor osteotomy supraorbital approach threadwire saw |
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