Infratemporal fossa approach to tumours of the temporal bone and base of the skull

Abstract

IN spite of the translabyrinthine and middle cranial fossa approaches, tumours situated in the infralabyrinthine and apical regions of the pyramid and surrounding portions of the base of the skull remain a surgical challenge for neurosurgeons and otolaryngologists as well. The transpalataltranspharyngeal route proposed by Mullan et al. (1966) and the transcochlear approach of House and Hitselberger (1976) do not provide adequate exposure for large glomus jugulare tumours, clivus chordomas, cholesteatomas and carcinomas invading the pyramid tip and skull base. The proper management of these lesions requires a larger approach permitting exposure of the internal carotid artery from the carotid foramen to the cavernous sinus (Fig. 1). The infratemporal fossa exposure presented in this paper is a possible solution to this problem. The basic features of the proposed lateral approach to the skull base are: (a) the permanent anterior displacement of the facial nerve, (b) the subluxation or permanent resection of the mandibular condyle, (c) the temporary displacement of the zygomatic arch, and (d) the subtotal petrosectomy with obliteration of the middle ear cleft. Three different types of infratemporal fossa approach have developed from the experience gained in 51 patients. They will be described and illustrated with typical cases. Surgical technique

Paraganglioma of the facial nerve, a rare differential diagnosis for facial nerve paralysis: case report and review of the literature

“…Depending on the location of the tumor (e.g., glomus tympanicum, glomus jugulare, glomus caroticum, glomus faciale) and its size (e.g., Fisch classification [10], cranial nerve involvement), the treatment of choice in patients with paraganglioma has generally shifted in recent years from radical resection to surgical tumor reduction with maintenance of function, as well as local control of any residual tumor tissue [11]. Depending on the individual case, local control may involve postoperative radiotherapy, or a ''wait-and-scan'' strategy can be used.…”

Outcomes of Facial Nerve in Lateral and Inferior Mastoid Approaches for Jugular Foramen and Petrous Apex Lesions

“…It also avoids infection in the operated field. 4 Further exposure of the jugular foramen/petrous apex region is determined by the tumor location, suspected pathology, aim of surgery, and neurovascular status of the patient prior to surgery. Intraoperative frozen section histology is routinely obtained to modify the surgical plan if necessary.…”

Cholesterol Granuloma of the Petrous Apex

“…Primary lesions account for approximately 40% of petrous apex lesions. [1][2][3][4][5][6] PATHOPHYSIOLOGY OF CHOLESTEROL GRANULOMA Cholesterol granuloma of the petrous apex forms as a result of foreign-body giant-cell reaction to cholesterol crystals. The poor ventilation, interference with drainage, and hemorrhage in a usually pneumatized space are predisposing factors leading to the formation of the cyst.…”

“…Primary petrous apex lesions are those that arise from the central petrous apex or the anatomic boundaries of the region, and account for approximately 40% of petrous apex lesions. [1][2][3][4][5][6] Secondary lesions impinge on the petrous apex from an outside source, which may derive from invasion from a bordering region or from a metastatic lesion; secondary lesions account for the remaining 60% of petrous apex lesions.…”