Transzygomatic approach plus mini-peeling of middle fossa for devascularization of sphenoid wing meningiomas. Technical note

Abstract

Background:Sphenoid wing meningiomas account for 20% of supratentorial meningiomas. The main supply of these tumors is provided by branches of the middle and accessory meningeal arteries. Surgical resection of meningiomas requires early tumor devascularization. Our objective is to present the role of transzygomatic approach plus mini-peeling of the anterior third of the middle fossa in the extradural identification and coagulation of branches of middle and accessory meningeal arteries involved in tumor supply.Methods:Ten formalin-fixed, silicone-injected cadaveric heads were used. On each side a transzygomatic approach plus mini-peeling of the anterior third of the middle fossa was performed. Between 2005 and 2017, the authors applied this technique for the resection of sphenoid wing meningiomas in 28 patients.Results:The mean age of patients was 54 years. Thirteen tumors could be classified as medial-third type, 6 as middle-third type, and 4 tumors were lateral-third type. Five tumors represented combined types. Of these, 3 tumors involved the medial and middle-third of the sphenoid wing and 2 involved the entire wing. Surgical resection was classified as Simpson I/II in 24 patients (86%). There were no permanent deficits or postoperative mortality.Conclusions:The transzygomatic approach combined with mini-peeling of the anterior third of the middle fossa is effective in allowing early devascularization of sphenoid wing meningiomas. These maneuvers are particularly important during resection of large tumors.

The Treatment Strategy for Skull Base Reconstruction for Anterior Cranial Fossa Intra- and Extracranial Tumors

“…Jian 14 also reported a retrospective study including 21 patients with cranioorbital tumors and found that cranio-orbital tumors can be removed effectively through transcranial orbitotomy, which can provide more convenient tumor exposure for the neurosurgeon. Attia 15 reported on 3 patients with a good outcome who underwent frontotemporal craniotomy and orbitozygomatic osteotomy, which has also been reported in many studies 16–18 . Campero 16 demonstrated that a 3-piece orbitozygomatic approach can provide excellent brain exposure with little retraction and a good cosmetic result.…”

“…Attia 15 reported on 3 patients with a good outcome who underwent frontotemporal craniotomy and orbitozygomatic osteotomy, which has also been reported in many studies. [16][17][18] Campero 16 demonstrated that a 3-piece orbitozygomatic approach can provide excellent brain exposure with little retraction and a good cosmetic result. Although these surgical approaches and techniques can provide good exposure for the tumor and satisfactory tumor resection, they also require larger bone windows, greater separation of the temporal muscles, and greater exposure of the dura, which may lead to more damage and more complications.…”