Orbitocranial zygomatic approach to middle cranial fossa (cavernous sinus and carotid artery, clivus, basilar artery or petrous apex) including osteotomy of zygoma, craniotomy, extra- or intradural elevation of temporal lobe
CPT4 code
Name of the Procedure:
Orbitocranial Zygomatic Approach to Middle Cranial Fossa
Common name(s): Zygomatic Craniotomy, Skull Base Surgery
Summary
The orbitocranial zygomatic approach to the middle cranial fossa is a complex surgical procedure designed to access the deep structures of the brain, including areas around the cavernous sinus, carotid artery, clivus, basilar artery, or petrous apex. The procedure involves making an incision to remove part of the zygomatic bone (cheekbone) and a section of the skull, followed by careful elevation of the temporal lobe to reach the target area.
Purpose
This surgery aims to treat various conditions affecting the base of the skull and surrounding structures. It is typically performed to remove tumors, treat vascular abnormalities, or address infections that standard access routes cannot reach. The expected outcome is the effective treatment or removal of these conditions while minimizing damage to surrounding brain structures.
Indications
- Presence of tumors (e.g., meningiomas, schwannomas) located in the middle cranial fossa.
- Vascular abnormalities like aneurysms of the basilar or carotid artery.
- Chronic infections or inflammatory conditions affecting the petrous apex or clivus.
- Cases where less invasive approaches are deemed insufficient or ineffective.
Preparation
- Patients will need to fast for at least 8 hours before surgery.
- Specific medications may need to be adjusted or temporarily stopped.
- Pre-operative imaging tests such as MRI or CT scans are required to map the surgical area.
- Blood tests and a thorough medical evaluation to assess fitness for the procedure.
Procedure Description
- Anesthesia: The patient is given general anesthesia to ensure they are completely unconscious and pain-free.
- Incision and Osteotomy: A surgical incision is made, and the zygoma (cheekbone) is partially removed (osteotomy).
- Craniotomy: A section of the skull is removed to expose the brain.
- Elevation of Temporal Lobe: The temporal lobe is carefully elevated to reach the target area, either through an extra- or intradural approach.
- Targeted Intervention: The specific treatment (tumor removal, aneurysm clipping, infection management) is performed.
- Closure: The bone and soft tissues are repositioned and secured, and the incision is closed with sutures.
Duration
The procedure typically takes 4 to 6 hours, depending on the complexity of the case.
Setting
This surgery is performed in a hospital's operating room, equipped for neurosurgical procedures.
Personnel
- Neurosurgeon
- Anesthesiologist
- Operating room nurses
- Surgical technicians
- Possible involvement of neuro-ophthalmologists or otolaryngologists, depending on the case
Risks and Complications
- Infection
- Bleeding
- Damage to cranial nerves, potentially affecting vision, facial movement, or hearing
- Cerebrospinal fluid leaks
- Brain swelling or unexpected neurological deficits
- Risks associated with general anesthesia
Benefits
- Effective removal or treatment of deep-seated brain tumors or vascular abnormalities.
- Relief from symptoms caused by the underlying condition.
- Potentially life-saving intervention.
Recovery
- Close monitoring in the intensive care unit (ICU) for at least 24-48 hours post-surgery.
- Pain management with medications.
- Regular neurological assessments.
- Gradual resumption of normal activities over several weeks.
- Follow-up appointments for wound assessment and further imaging tests.
Alternatives
- Stereotactic radiosurgery (Gamma Knife or CyberKnife) for suitable small or medium-sized tumors.
- Endoscopic approaches for accessible lesions.
- Medication or radiation therapy, depending on the condition.
- Each alternative has its benefits and limitations and may not be suitable for all patients.
Patient Experience
- During the procedure: The patient will be under general anesthesia and unaware of the surgery.
- After the procedure: Pain and discomfort in the surgical area, managed with analgesics.
- Possible initial swelling and bruising around the eye and cheek.
- Temporary limitations on physical activities.
- Gradual improvement and return to normal functions with ongoing support and follow-up care.