Orbitozygomatic approach for treatment of aneurysms: Review of 100 cases

The orbitozygomatic craniotomy is an extremely useful skullbase approach for treating intracranial aneurysms. We review our experience with 100 consecutive cases in which the orbitozygomatic craniotomy was used to treat 120 aneurysms (single aneurysm in 81 patients, multiple aneurysms in 19 pa-tients) over a 3-year period. The most common aneurysm locations were the anterior communicating (40), middle cerebral (22), basilar tip (14), and internal carotid arteries (12). In decreasing frequency, other locations included the posterior communicating, posterior cerebral, ophthalmic, superior cerebellar, anterior cerebral, and anterior choroidal arteries. In each case, the orbitozygomatic craniotomy was chosen to maximize exposure while minimizing the need for retraction. The approach also offers a shorter working distance and improves the angle for clip application. This versatile approach can be tailored to treat aneurysms successfully at a variety of locations typically addressed with other surgical approaches.