Transzygomatic Approach to Ventrolateral Craniotomy/Craniectomy

The transzygomatic approach to intracranial surgery has been advanced and frequently modified over the last three decades in human medicine. This technique provides excellent access to the middle fossa and the cavernous sinus. Similarly, in veterinary medicine, this approach has been described by several authors with a variety of adaptations most commonly involving removal of a portion of the zygomatic arch. An incision is made between the lateral canthus and the tragus at the level of the dorsal aspect of the zygomatic arch. Prior to dissection, the zygomatic arch, lateral rim of the orbit, and temporomandibular joint are identified by gentle palpation. The zygomatic arch has three parts: the zygomatic process of the maxilla, the zygomatic bone, and the zygomatic process of the temporal bone. Prior to closure, complete hemostasis should be achieved with a combination of chilled saline, hemostatic agents, and foam sponges.