[Respective indications of orbital and/or zygomatic arch removal combined with fronto-pteriono-temporal approaches. 58 cases].

Orbito- and or zygomatic arch removal associated to fronto-pteriono-temporal craniotomy can be useful to minimize brain retraction and achieve optimal exposure with the shortest possible distance and the most adequate view angle, in the approa-ch of difficult lesions located in the vicinity of the skull base via a supratentorial route. Fifty-eight patients admitted for such difficult lesions were operated on by the authors between 1988 and 1993 using orbital and/or zygomatic removal. Mortality 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 sequel was observed. From this experience, the authors suggest the respective indications orbit-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 anterior circulation, to mesio-temporal lesions; simple zygoma arch removal for approaching infra-temporal lesions, the Meckel's cave, the circumpeduncular cistern and aneurysms of the P2 portion of the posterior cerebral artery.