Transfacial access for neurosurgical procedures: An extended role for the maxillofacial surgeon. II. Middle cranial fossa, infratemporal fossa and pterygoid space

1991 ◽  
Vol 20 (5) ◽  
pp. 291-295 ◽  
Author(s):  
Peter David Grime ◽  
Richard Haskell ◽  
Iain Robertson ◽  
Richard Gullan
Keyword(s):  
Infratemporal Fossa ◽  
Middle Cranial Fossa ◽  
Neurosurgical Procedures ◽  
Cranial Fossa

scholarly journals Pediatric multicompartmental trigeminal schwannoma: illustrative case

2021 ◽  
Vol 1 (20) ◽  
Author(s):  
Alexander P. Landry ◽  
Vincent C. Ye ◽  
Kerry A. Vaughan ◽  
James M. Drake ◽  
Peter B. Dirks ◽  
...  
Keyword(s):  
Skull Base ◽  
Infratemporal Fossa ◽  
Middle Cranial Fossa ◽  
Surgical Approaches ◽  
Illustrative Case ◽  
Trigeminal Schwannoma ◽  
Skull Base Lesions ◽  
Cranial Fossa ◽  
Extradural Approach

BACKGROUND Trigeminal schwannoma (TS) is an uncommon and histologically benign intracranial lesion that can involve any segment of the fifth cranial nerve. Given its often impressive size at diagnosis and frequent involvement of critical neurovascular structures of the skull base, it represents a challenging entity to treat. Pediatric TS is particularly rare and presents unique challenges. Similarly, tumors with extension into multiple compartments (e.g., middle cranial fossa, posterior cranial fossa, extracranial spaces) are notoriously difficult to treat surgically. Combined or staged surgical approaches are typically required to address them, with radiosurgical treatment as an adjunct. OBSERVATIONS The authors presented the unusual case of a 9-year-old boy with a large, recurrent multicompartmental TS involving Meckel’s cave, the cerebellopontine angle, and the infratemporal fossa. Near-total resection was achieved using a frontotemporal-orbitozygomatic craniotomy with a combined interdural and extradural approach. LESSONS The case report adds to the current literature on multicompartmental TSs in children and their management. The authors also provided a simplified classification of TS that can be generalized to other skull base tumors. Given a lack of precedent, the authors intended to add to the discussion regarding surgical management of these rare and challenging skull base lesions.

scholarly journals The Lower Cheek Flap Combined with Neurosurgical Approach for Infratemporal Fossa Tumour

2010 ◽  
Vol 25 (1) ◽  
pp. 17-19
Author(s):  
Aneeza Khairiyah W. Hamizan ◽  
Mazita Ami ◽  
Azizi Abu Bakar ◽  
Mohd Razif Mohamad Yunus
Keyword(s):  
Case Report ◽  
Infratemporal Fossa ◽  
Middle Cranial Fossa ◽  
Combined Approach ◽  
Aesthetic Outcome ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Cranial Fossa ◽  
Design Case ◽  
Cheek Flap

Objective: To describe our experience in performing the lower cheek flap for access to the infratemporal fossa combined with the neurosurgical approach. Methods: Study design: Case report Setting: Tertiary Referral Center Patients: Two Result: Two unusual tumours involving the infratemporal and middle cranial fossa were excised using this combined approach. The infratemporal fossa tumour was accessed via the lower cheek flap while the intracranial portion was resected from above via craniotomy. Conclusion: The lower cheek flap in combination with the neurosurgical approach allows optimal exposure to tumours involving the infratemporal and middle cranial fossae. It has less complications and better aesthetic outcome compared to other approaches. Keywords: Lower cheek flap, infratemporal fossa tumour      

Endoscopic anterior transmaxillary “transalisphenoid” approach to Meckel’s cave and the middle cranial fossa: an anatomical study and clinical application

2018 ◽  
Vol 130 (1) ◽  
pp. 227-237 ◽  
Author(s):  
Huy Q. Truong ◽  
Xicai Sun ◽  
Emrah Celtikci ◽  
Hamid Borghei-Razavi ◽  
Eric W. Wang ◽  
...  
Keyword(s):  
Maxillary Sinus ◽  
Cavernous Sinus ◽  
Infratemporal Fossa ◽  
Middle Cranial Fossa ◽  
Anatomical Landmarks ◽  
Middle Fossa ◽  
Meckel’S Cave ◽  
Meckel's Cave ◽  
Cranial Fossa ◽  
Greater Wing

OBJECTIVEMultiple approaches have been designed to reach the medial middle fossa (for lesions in Meckel’s cave, in particular), but an anterior approach through the greater wing of the sphenoid (transalisphenoid) has not been explored. In this study, the authors sought to assess the feasibility of and define the anatomical landmarks for an endoscopic anterior transmaxillary transalisphenoid (EATT) approach to Meckel’s cave and the middle cranial fossa.METHODSEndoscopic dissection was performed on 5 cadaver heads injected intravascularly with colored silicone bilaterally to develop the approach and define surgical landmarks. The authors then used this approach in 2 patients with tumors that involved Meckel’s cave and provide their illustrative clinical case reports.RESULTSThe EATT approach is divided into the following 4 stages: 1) entry into the maxillary sinus, 2) exposure of the greater wing of the sphenoid, 3) exposure of the medial middle fossa, and 4) exposure of Meckel’s cave and lateral wall of the cavernous sinus. The approach provided excellent surgical access to the anterior and lateral portions of Meckel’s cave and offered the possibility of expanding into the infratemporal fossa and lateral middle fossa and, in combination with an endonasal transpterygoid approach, accessing the anteromedial aspect of Meckel’s cave.CONCLUSIONSThe EATT approach to Meckel’s cave and the middle cranial fossa is technically feasible and confers certain advantages in specific clinical situations. The approach might complement current surgical approaches for lesions of Meckel’s cave and could be ideal for lesions that are lateral to the trigeminal ganglion in Meckel’s cave or extend from the maxillary sinus, infratemporal fossa, or pterygopalatine fossa into the middle cranial fossa, Meckel’s cave, and cavernous sinus, such as schwannomas, meningiomas, and sinonasal tumors and perineural spread of cutaneous malignancy.

Endoscopic approaches to the trigeminal nerve and clinical consideration for trigeminal schwannomas: a cadaveric study

2012 ◽  
Vol 117 (4) ◽  
pp. 690-696 ◽  
Author(s):  
Fuminari Komatsu ◽  
Mika Komatsu ◽  
Antonio Di Ieva ◽  
Manfred Tschabitscher
Keyword(s):  
Trigeminal Nerve ◽  
Infratemporal Fossa ◽  
Lateral Wall ◽  
Middle Cranial Fossa ◽  
Minimal Invasiveness ◽  
Trigeminal Schwannoma ◽  
Minimally Invasive Surgical ◽  
Anterior Petrosectomy ◽  
Cranial Fossa ◽  
Neurovascular Structures

Object The course of the trigeminal nerve straddles multiple fossae and is known to be very complex. Comprehensive anatomical knowledge and skull base techniques are required for surgical management of trigeminal schwannomas. The aims of this study were to become familiar with the endoscopic anatomy of the trigeminal nerve and to develop a minimally invasive surgical strategy for the treatment of trigeminal schwannomas. Methods Ten fresh cadavers were studied using 5 endoscopic approaches with the aid of 4-mm 0° and 30° endoscopes to identify surgical landmarks associated with the trigeminal nerve. The endoscopic approaches included 3 transcranial keyhole approaches (the extradural supraorbital, extradural subtemporal, and retrosigmoid approaches), and 2 endonasal approaches (the transpterygoid and the transmaxillary transpterygoid approaches). Results The trajectories of the extradural supraorbital, transpterygoid, and extradural subtemporal approaches corresponded with the course of the first, second, and third divisions of the trigeminal nerve, respectively. The 3 approaches demonstrated each division in intra- and extracranial spaces, as well as the Meckel cave in the middle cranial fossa. The interdural space at the lateral wall of the cavernous sinus was exposed by the extradural supraorbital and subtemporal approaches. The extradural subtemporal approach with anterior petrosectomy and the retrosigmoid approach visualized the trigeminal sensory root and its neighboring neurovascular structures in the posterior cranial fossa. The transmaxillary transpterygoid approach revealed the course of the third division in the infratemporal fossa. Conclusions The 5 endoscopic approaches effectively followed the course of the trigeminal nerve with minimal invasiveness. These approaches could provide alternative options for the management of trigeminal schwannoma.

Rare Giant Epidermal Cyst in the Infratemporal Fossa and Middle Cranial Fossa

2012 ◽  
Vol 23 (4) ◽  
pp. e334-e336 ◽  
Author(s):  
Tao Yang ◽  
Li Zhang ◽  
Haihong Bao ◽  
Zequan Hua
Keyword(s):  
Infratemporal Fossa ◽  
Middle Cranial Fossa ◽  
Epidermal Cyst ◽  
Cranial Fossa

A combined frontotemporal and lateral infratemporal fossa approach to the skull base

1988 ◽  
Vol 68 (5) ◽  
pp. 678-683 ◽  
Author(s):  
Bruce Mickey ◽  
Lanny Close ◽  
Steven Schaefer ◽  
Duke Samson
Keyword(s):  
Cavernous Sinus ◽  
Infratemporal Fossa ◽  
Middle Cranial Fossa ◽  
Low Grade ◽  
Orbital Apex ◽  
Upper Aerodigestive Tract ◽  
Temporalis Muscle ◽  
Anterior Portion ◽  
Content Type ◽  
Cranial Fossa

✓ A variety of neoplasms involve both the infratemporal fossa and the base of the middle cranial fossa, in medial proximity to the cavernous sinus and orbital apex. To provide simultaneous access to both the intracranial and extracranial aspects of these tumors, a temporal or frontotemporal craniotomy may be combined with a lateral exposure of the infratemporal fossa. The approach, which is readily achieved by a neurosurgeon and an otolaryngologist acting as a team, involves a unilateral frontotemporal incision extended inferiorly onto the neck, a lateral facial flap reflected anteriorly, and transection of the zygoma followed by its reflection inferolaterally with the temporalis muscle. This exposure provides excellent visualization of both the intradural and extradural aspects of the anterior portion of the cavernous sinus, allowing for an aggressive resection of neoplasms involving this region. Experience with this procedure is reported here in the management of nine patients: three with nasopharyngeal angiofibromas, three with low-grade malignancies of the upper aerodigestive tract, and three with sphenoid ridge meningiomas.

Extended Middle Cranial Fossa Approach for Lesions Invading Infratemporal Fossa: Anatomic Study and Clinical Application

2020 ◽  
Vol 138 ◽  
pp. 83
Author(s):  
Luciano Mastronardi ◽  
Francesco Corrivetti ◽  
Carlo Giacobbo Scavo ◽  
Guglielmo Cacciotti ◽  
Raffaelino Roperto ◽  
...  
Keyword(s):  
Clinical Application ◽  
Infratemporal Fossa ◽  
Middle Cranial Fossa ◽  
Anatomic Study ◽  
Middle Cranial Fossa Approach ◽  
Cranial Fossa

Surgical Approaches to the Cavernous Sinus: A Microsurgical Study

Neurosurgery ◽  
1990 ◽  
Vol 26 (6) ◽  
pp. 903-932 ◽  
Author(s):  
Tooru Inoue ◽  
Albert L. Rhoton ◽  
Dan Theele ◽  
Margaret E. Barry
Keyword(s):  
Carotid Artery ◽  
Cavernous Sinus ◽  
Infratemporal Fossa ◽  
Lateral Wall ◽  
Middle Cranial Fossa ◽  
Surgical Approaches ◽  
Anterior Clinoid Process ◽  
Anatomic Variants ◽  
Cranial Fossa ◽  
Extradural Approach

Abstract The surgical approaches to the cavernous sinus were examined in 50 adult cadaveric cavernous sinuses using magnification of ×3 to ×40. The following approaches were examined: 1) the superior intradural approach directed through a frontotemporal craniotomy and the roof of the cavernous sinus: 2) the superior intradural approach combined with an extradural approach for removing the anterior clinoid process and unroofing the optic canal and orbit; 3) the superomedial approach directed through a supraorbital craniotomy and subfrontal exposure to the wall of the sinus adjacent to the pituitary gland; 4) the lateral intradural approach directed below the temporal lobe to the lateral wall of the sinus; 5) the lateral extradural approach for exposure of the internal carotid artery in the floor of the middle cranial fossa proximal to the sinus; 6) the combined lateral and inferolateral approach, in which the infratemporal fossa was opened and the full course of the petrous carotid artery and the lateral wall of the sinus were exposed and; 7) the inferomedial approach, in which the medial wall of the sinus was exposed by the transnasal-transsphenoidal route. It was clear that a single approach was not capable of providing access to all parts of the sinus. The intracavernous structures best exposed by each route are reviewed. The osseous relationships in the region were examined in dry skulls. Anatomic variants important in exposing the cavernous sinus are reviewed.

Surgical treatment of juvenile nasopharyngeal angiofibroma with intracranial extension

2009 ◽  
Vol 4 (2) ◽  
pp. 113-117 ◽  
Author(s):  
Nevo Margalit ◽  
Oshri Wasserzug ◽  
Ari De-Row ◽  
Avraham Abergel ◽  
Dan M. Fliss ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Adjuvant Therapy ◽  
Infratemporal Fossa ◽  
Middle Cranial Fossa ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Intracranial Extension ◽  
Nasopharyngeal Angiofibroma ◽  
Cranial Fossa ◽  
Midfacial Degloving

Object The purpose of this study was to describe the surgical treatment and outcomes of patients with intracranial extension of juvenile nasopharyngeal angiofibroma (JNA). Methods Twenty-one patients who underwent operations for JNAs between 1994 and 2008 were enrolled in the study. Seven patients (33%) had intracranial tumor extension. The middle cranial fossa and cavernous sinus were involved in 4 patients who underwent operations via the combined infratemporal fossa-midfacial degloving approach. The anterior skull base was involved in 3 patients who underwent the subcranialmidfacial degloving approach. Results Complete tumor removal was achieved in all patients. Postoperative complications included 1 case of soft-tissue infection. None of the patients had tumor recurrence after a mean follow-up of 42 months (range 29–85 months). No adjuvant therapy was required in any patient. Conclusions Combined approaches can be used effectively for treatment of JNAs with intracranial extension without the need for adjuvant therapy.

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