Superior eyelid crease approach for transobital neuroendoscopic surgery of the anterior cranial fossa.

Access to the anterior cranial fossa has traditionally required a large exposure of the surgical field, which can be a source of aesthetic and neurologic morbidity. Minimally invasive surgery approaches have been developed to overcome these adverse effects and was, for a long time, represented by endonasal endoscopic surgery. The superior eyelid crease approach of the anterior cranial fossa with supraorbital osteotomy was described in the early 80s as an interesting alternative to the endonasal approach. This keyhole endoscopic approach allows safe and efficient surgery of the orbit, the anterior cranial fossa, and the mesiotemporal lobe. We successfully treated 10 patients with benign tumors of the anterior cranial fossa, with excellent cosmetic results and no complications. This study presents the surgical technique and its potential indication and limits throughout our experience as well as a review of the literature.

Rapid prototyping in craniofacial surgery: using a positioning guide after zygomatic osteotomy - A case report.

INTRODUCTION: The management of post-traumatic deformity in the midface region poses challenges for the maxillofacial surgeon. Ensuring symmetry after zygomatic osteotomy can be difficult and precise positioning of the osteotomised bony fragments requires careful treatment planning. It may be necessary to use a coronal flap to allow the surgeon to compare the contralateral zygomatic bone to allow symmetrical reduction. The authors present a new technique for the positioning of osteotomised zygomatic bones using a combination of computer assisted surgical simulation and rapid prototyping. METHOD: A patient presented to our unit with a post-traumatic zygomatic deformity. Using surgical simulation software the displaced zygomatic bone was osteotomised and placed in the idéal position on a three-dimensional computed tomography scan (3D CT). The position was determined by reference to the contralateral zygoma. In addition the repositioning of the soft tissues was simulated. A surgical guide which allowed intraoperative positioning of the osteotomised zygoma was manufactured by a rapid prototyping process. Use of the guide allowed a minimally invasive approach to the affected zygoma. The post-operative results were compared to the predicted outcome. RESULTS: The post-operative appearance was satisfactory and corresponded well with the predicted result. There was a significant reduction in operative time compared to the previous management of similar cases.