Infratemporal Fossa Approach for Lesions in the Temporal Bone and Base of the Skull

Fisch, Ugo

doi:10.1159/000409856

Cited by 119 publications

(149 citation statements)

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“…Finally, high resolution computed tomography (CT) scans were performed in all patients to explore the anatomy of the jugular foramen and posterior fossa, the temporal bone and the occipital condyles. Tumours were classified according to Fisch's classification [7] (see Table 1). Our series did not include type A and B of Fisch's classification and consequently, no actual tympanic tumour.…”

Section: Methodsmentioning

confidence: 99%

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Jugular foramen paragangliomas: management, outcome and avoidance of complications in a series of 75 cases

et al. 2011

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Jugular foramen paragangliomas are rare skull base tumours posing multiple complex diagnostic and management problems. We did a study to evaluate surgical technique, outcome and complications in 75 cases of tumours treated by multidisciplinary approach (i.e. combined neurosurgery, neuroradiology, ear, nose and throat surgery and intensive care unit team). Retrospective study on 75 consecutive patients with jugular foramen paragangliomas treated surgically from 1989 to 2005. Preoperative balloon occlusion test was performed in all patients as well as embolization (100%). A combined limited infratemporal and juxtacondylar approach was used in all patients. Gross total resection was achieved in 59 patients (78.7%). The most common complication was represented by lower cranial nerve deficits in five patients (6.6%), which was only temporary in three. Postoperative facial nerve weakness occurred in five cases (6.6%) and resolved in three of them. The remaining two patients underwent facial nerve reconstruction by hypoglossal/facial nerve anastomosis. Four patients (5.3%) had a postoperative cerebrospinal fluid leak, which was successfully treated by lumbar drainage. Two patients (2.7%) died because of complications related to surgical injury of lower cranial nerves: one patient developed aspiration pneumonia and septicemia and the second one developed a large cervico-bulbar hematoma that led to severe respiratory distress and ultimately global cerebral hypoxia. Paragangliomas are rare and complex skull base lesions that may be managed with low morbidity and mortality if a multidisciplinary approach is considered. Facial and lower cranial nerve postoperative deficits can be limited.

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Section: Methodsmentioning

confidence: 99%

“…In 1977, Fisch [7] described a variation of the Gallard and Rebattu's cervicomastoid approach, which was named the "infratemporal approach". More recently, in 1995, the juxtacondylar approach was described by George et al [8,9]; it uses a dissection that begins from the lateral craniocervical junction.…”

Section: Surgical Approachesmentioning

confidence: 99%

Jugular foramen paragangliomas: management, outcome and avoidance of complications in a series of 75 cases

et al. 2011

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“…ClassiWcation of PBC has evolved from two classes proposed by Fish [7] to the Wve classes proposed by Sanna et al [1], and recently, to the seven classes proposed by MoVat and Smith [2]. In all classiWcations the labyrinthine block was chosen as the reference due to its central position within the petrous bone and its functional importance.…”

Section: Discussionmentioning

confidence: 99%

Management of petrous bone cholesteatoma: open versus obliterative techniques

López

Gómez

Bernardo

et al. 2010

Eur Arch Otorhinolaryngol

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The objective of this study was to expose our results in the treatment of petrous bone cholesteatomas (PBC), paying attention to diagnosis, surgical strategy, facial management, results, and recurrences. The main objective is to compare the results of obliterative and open techniques in their management concerning the recurrence rate, due to the controversy elicited on obliterative or closed techniques in large cholesteatomas. A retrospective study was performed from July 1977 to September 2007 at the Tertiary referral cranial base center. Thirty-five patients were treated for PBC through different surgical approaches, and in 25 cases (72%) the surgical cavity was obliterated with a muscle flap. Four patients (11%) had a long-term recurrence. These patients received an open technique and after surgical re-exploration using a closed technique they had no recurrence. There were no recurrences in patients who underwent an obliterative technique and they received periodic MRI controls. The facial function after surgery was acceptable (71% of patients had House-Brackmann grades I to III). PBC is a complex pathology and presents difficulties in its diagnosis and treatment. Surgical technique should be suitable for removing the pathology and preventing damage to structures such as the facial nerve or great vessels. Obliterative techniques, where possible, are at least as safe as open cavity procedures and they have fewer postoperative complications; however, regular follow-up with CT and MRI is mandatory.

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“…This concept is inherently different from total obliteration of the tympanomastoid cleft and its complete isolation from the environment as practiced by the senior author (U. Fisch) under the term of subtotal petrosectomy since the late 1960 s [2,4,7,10,24]. It implies the complete exenteration of all accessible air-cell tracts of the temporal bone, leaving only the otic capsule and the cortical bone covering the dura, jugular bulb, carotid, and the facial nerve.…”

Section: Discussionmentioning

confidence: 99%

Cochlear implantation after subtotal petrosectomies

Bendet¹,

Cerenko

Linder

et al. 1998

European Archives of Oto-Rhino-Laryngology

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Among cochlear implant candidates there are patients who have abnormal middle and/or inner-ear conditions that make them unsuitable for implantation. Insertion of a foreign body may also be contraindicated in the setting of an existing or potential intracranial communication, or when the ear is prone to infection. Five patients presented with such unfavorable conditions. These included a Mondini dysplasia with persistent cerebrospinal fluid leak, an atretic mastoid with meningocele, chronic otitis media, a transverse petrous bone fracture, and a temporal bone adenoma. All patients underwent subtotal petrosectomies and cochlear implantations. In four cases implantation was performed concomitantly with subtotal petrosectomy, while the remaining case required a two-stage procedure. No complications occurred. The technique is described in detail, and the cases and the indications for surgery are discussed. By obliterating and isolating the tympanomastoid cleft from the outer environment and utilizing the technique of subtotal petrosectomy, a broader spectrum of patients can now be implanted safely.

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Infratemporal Fossa Approach for Lesions in the Temporal Bone and Base of the Skull

Cited by 119 publications

References 0 publications

Jugular foramen paragangliomas: management, outcome and avoidance of complications in a series of 75 cases

Jugular foramen paragangliomas: management, outcome and avoidance of complications in a series of 75 cases

Management of petrous bone cholesteatoma: open versus obliterative techniques

Cochlear implantation after subtotal petrosectomies

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