Anatomical Basis of the Orbitozygomatic Approach

The approach to the anterior and middle cranial fossae poses significant challenges for neurosurgeons due to the numerous critical structures encountered in this region. The orbitozygomatic approach (OZA), developed as an extension of the pterional approach (PA), allows access not only to the anterior and middle cranial fossae but also to the orbit. Therefore, a thorough understanding of the regional anatomy is essential to minimize surgical risks. The objective of this study is to describe the anatomy of the OZA, emphasizing the anatomical landmarks relevant to the approach. This study was conducted using five cadaveric heads preserved in 5% formalin, one dry skull, standard dissection instruments, a drill and Gigli saw, a high-speed drill, and a high-resolution camera. A stepwise, layer-by-layer dissection was performed to detail the anatomical features of the approach. The OZA provides broad access to the cranial fossae and orbit with reduced brain retraction, thereby minimizing potential damage to the parenchyma and surrounding neurovascular structures. Dissection began with the superficial layers (skin, subcutaneous tissue, temporalis muscle, and skull) to reduce approach-related morbidity. After performing the craniotomy, the temporal and frontal lobes, orbit, and lateral fissure were widely exposed. Dissection of the lateral fissure enabled access to deeper structures via multiple pathways. With meticulous microsurgical technique, this approach creates a wide and practical surgical corridor. However, its complexity lies in the proximity to deep vascular structures, where inadvertent injury may result in significant morbidity and mortality. The OZA is a highly complex approach, requiring extensive anatomical knowledge and practice. Cadaveric dissection provides a three-dimensional and topographic understanding of the neurovascular relationships along the surgical route, thereby enhancing the surgeon’s familiarity with the region and ultimately improving clinical outcomes.