Surgical Strategy for Tumors Located in or Extending From the Intracranial Space to the Infratemporal Fossa -Advantages of the Transcranial Approach (Zygomatic Infratemporal Fossa Approach) and the Indications for a Combined Transcranial and Transcervical Approach-

Abstract

The surgical strategy for tumors located in or extending from the intracranial space to the infratemporal fossa was analyzed in 12 cases with various pathologies. A case of mandibular nerve schwannoma, which extended 1 cm below the external orifice of the foramen ovale, was completely removed via the epidural subtemporal approach without zygomatic osteotomy with partial removal of the middle cranial base. The inferior margin of infratemporal tumor could be accessed via the transcranial route with zygomatic or orbitozygomatic osteotomy without complications including facial nerve injury in nine cases, and the lowest level of the infratemporal tumors was approximately 4.5 cm below the outer surface of the middle cranial base. In five of these 9 cases (2 schwannomas, 1 myxoma, 1 chondrosarcoma, and 1 malignant peripheral nerve sheath tumor), the tumors were localized in the infratemporal fossa, and in the other 4 cases (2 meningiomas, 1 glioblastoma, and 1 ameloblastoma), the tumors extended to both the intracranial space and the infratemporal fossa. In two cases (recurrent jugular schwannoma and mandibular osteosarcoma), a combined transcranial and transcervical approach (mandibular swing approach) was essential, because the resection line of the lower margin was too far from the middle cranial base. These results indicate that the transcranial approach, with or without zygomatic or orbitozygomatic osteotomy (zygomatic infratemporal fossa approach), is safe and effective for removal of some infratemporal tumors, and that a combined transcranial and transcervical approach is useful for removing infratemporal tumors with extensive downward extension.

Anterior endoscopic sublabial transmaxillary access to middle cranial base lesions

“…In comparison with a pure endonasal access, relative benefits include the surgeon's greater freedom to work in the maxilla, a shorter distance to the lesion, being in line with the lesion, easier vascular control, adequate access to the temporal fossa, the ability to manage large tumors of the MCF, easier control of upper and lower parapharyngeal space extensions, and no need to create a sinonasal corridor (Figures 3–5). 4,5,14 …”

“…maxilla, a shorter distance to the lesion, being in line with the lesion, easier vascular control, adequate access to the temporal fossa, the ability to manage large tumors of the MCF, easier control of upper and lower parapharyngeal space extensions, and no need to create a sinonasal corridor (Figures 3-5). 4,5, 14 Truong et al presented two cases of the endoscopic sublabial transmaxillary approach to Meckel's cave and MCF. In a patient with SCC and perineural trigeminal spread, they performed gross total tumor resection from ION, IOF, and ITF.…”

Clival intraosseous myxoma treated with an endoscopic endonasal approach: illustrative case

“…Additionally, articles were filtered for the English language with full-text availability, which revealed 22 articles total (Table 1). 4,8,9,11,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] Of these, two articles reported intraosseous myxomas arising in the clival region, in a total of five patients. 8,9 Our case report is one of the few reports of this pathology treated with an endoscopic endonasal operative approach.…”

An Oncoplastic Approach to Primary Pediatric Pterygomaxillary Osteosarcoma

“…3,11,13 Tumors within the pterygomaxillary recess/infratemporal fossa are difficult to access surgically, and resection may be associated with significant risks, including facial nerve injury and extensive scarring from transfacial incisional approaches. 13,14,17 Detailed planning is needed to ensure maximization of function and minimization of morbidity with surgical treatment. Optimization of cosmesis is also of importance in young, growing children.…”