RESPECTIVE INDICATIONS OF ORBITAL AND OR ZYGOMATIC ARCH REMOVAL ASSOCIATED TO FRONTO-PTERIONO-TEMPORAL APPROACHES - EXPERIENCE WITH 58 CASES/

Orbito- andor zygomatic arch removal associated to fronto-pteriono-tem poral craniotomy can be useful to minimize brain retraction and achiev e optimal exposure with the shortest possible distance and the most ad equate view angle, in the approa-ch of difficult lesions located in th e vicinity of the skull base via a supratentorial route. Fifty-eight p atients admitted for such difficult lesions were operated on by the au thors between 1988 and 1993 using orbital and/or zygomatic removal. Mo rtality rate was 1,7 %. Complications due to orbital and/or zygomatic removal amounted at 15 %, but were mostly transient. Sequels owned to excessive brain retraction were less than 10 %. No bony cosmetic seque l was observed. From this experience, the authors suggest the respecti ve indications orbite-zygomatic : removal for access to the cavernous sinus, supra-sellar region, tentorial notch, inter-peduncular cistern; simple orbital arch removal for access to complex aneurysms of the an terior circulation, to mesio-temporal lesions; simple zygoma arch remo val for approaching infra-temporal lesions, the Meckel's cave, the cir cumpeduncular cistern and aneurysms of the P2 portion of the posterior cerebral artery.