CPT® Code 61592

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

The orbitocranial zygomatic approach to the middle cranial fossa (MCF) is a surgical technique utilized primarily for accessing and treating various conditions affecting the orbit, sinus, and auditory structures. This approach is particularly relevant for the resection of neoplastic tumors and vascular lesions that may be located in these areas. The MCF is anatomically situated between the anterior and posterior cranial fossas, with its floor formed by critical bony structures including the body and greater wings of the sphenoid bone, the squamous part of the temporal bone, and the anterior surface of the temporal petrous bone. The procedure begins with an incision in the scalp, strategically placed along the inferior border of the zygomatic arch and extending upward and forward to intersect at the contralateral midpupillary line, ensuring minimal disruption to the hairline. This careful incision allows for the elevation of a scalp flap, which is essential for accessing the underlying temporal fascia. Surgeons must take particular care to preserve the frontal branch of the facial nerve during this process, as it is crucial for maintaining facial function. The subsequent steps involve meticulous dissection and elevation of the temporal muscle, as well as the creation of burr holes in the temporal bone to facilitate the removal of a bone flap. This approach not only provides access to the MCF but also allows for the examination and potential intervention on critical vascular structures such as the cavernous sinus and carotid artery, as well as the clivus, basilar artery, and petrous apex. Ultimately, the orbitocranial zygomatic approach is a complex yet vital technique in neurosurgery, enabling the treatment of significant intracranial pathologies while minimizing damage to surrounding tissues.