• K M Abdel Aziz, S C Froelich, P L Cohen, A Sanan, J T Keller, and H R van Loveren.
• Department of Neurosurgery, University of Cincinnati, College of Medicine, Ohio 45267-0515, USA.
• Acta Neurochir (Wien). 2002 Jan 1; 144 (1): 15-24.

ObjectiveUse of the MacCarty keyhole burr hole and the inferior orbital fissure provides simplicity and safety to perform the one-piece frontotemporal orbitozygomatic (FTOZ1) approach.MethodsWe performed the FTOZ1 approach with its three subtypes (i.e., total, temporal, and frontal) in cadaveric head specimens in the Goodyear Laboratory and subsequently in surgical cases.ResultsThe orbitozygomatic osteotomy, when added to a frontotemporal craniotomy, comprises the frontotemporal orbitozygomatic (FTOZ) approach, provides an expanded exposure to the anterior and middle cranial fossae, and enables the surgeon to create a window to the posterior cranial fossa. The MacCarty burr hole is used to facilitate orbital cuts, and the anterolateral portion of the inferior orbital fissure connects the orbital cuts to the zygomatic cuts. This allows the FTOZ1 craniotomy flap to be "out-fractured" with ease. The three types of FTOZ1 approach, i.e., the total, the temporal, and the frontal, are described step by step.ConclusionsUnderstanding the MacCarty keyhole burr hole and the microsurgical anatomy of the inferior orbital fissure is essential to performing the FTOZ1 approach. The three types of FTOZ1 approach enable the surgeon to tailor the approach according to the surgical exposure needed for each lesion.

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