scholarly journals Transzygomatic anterior infratemporal fossa approach and high cervical approach for resection of infra temporal fossa and parapharyngeal space solitary fibrous tumours

2019 ◽  
pp. 492-497
Author(s):  
Kazumi Ohmori ◽  
Shiduka Kamiyoshi ◽  
Taku Takeuchi ◽  
Takanori Fukushima ◽  
Takashi Tsuduki ◽  
...  
Keyword(s):  
Parapharyngeal Space ◽  
Infratemporal Fossa ◽  
Cranial Nerves ◽  
Surgical Approaches ◽  
Surgical Removal ◽  
Middle Fossa ◽  
Temporal Fossa ◽  
Solitary Fibrous Tumours ◽  
The 1960S ◽  
Superior Portion

The infratemporal fossa (ITF) is the region under the floor of the middle fossa giving passage to most major cerebral vessels and cranial nerves.(1) It is closely related to important adjacent regions such as the middle fossa, pterygopalatine fossa, orbit, and nasopharynx.(2) Due to the anatomical complexity in the ITF, surgical removal of the lesions in or around it is still challenging.(3) Since the 1960s, many surgeons have reported various surgical approaches. the preauricular transzygomatic approach via a transcranial route was reported to be used for exposure of the antero-superior portion of the ITF (2,3). Solitary fibrous tumours (SFTs) were first described by Klempere and Rabin in 1931 as spindle-cell tumours originating from the pleura.(4) With the exception of myopericytoma, infantile myofibromatosis and HPC-like lesions of the sinonasal tract showing myoid differentiation, all other HPC like lesions are best considered as subtypes of SFT.(5) Only a few cases of SFT have been described in the literature involving the skull base and parapharyngeal space.(6–8) The purpose of this article is to show anatomical dissections involving this surgical approach and to evaluate our surgical experience using it.

Zygomatic Approach to Cavernous Sinus Chordoma: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Antonio Aversa ◽  
Ossama Al-Mefty
Keyword(s):  
Carotid Artery ◽  
Cavernous Sinus ◽  
Infratemporal Fossa ◽  
Cranial Nerves ◽  
Radical Resection ◽  
High Rate ◽  
Petrous Apex ◽  
High Dose ◽  
Middle Fossa ◽  
Cavernous Carotid Artery

Abstract Chordoma is not a benign disease. It grows invasively, has a high rate of local recurrence, metastasizes, and seeds in the surgical field.1 Thus, chordoma should be treated aggressively with radical resection that includes the soft tissue mass and the involved surrounding bone that contains islands of chordoma.2–5 High-dose radiation, commonly by proton beam therapy, is administered after gross total resection for long-term control. About half of chordoma cases occupy the cavernous sinus space and resecting this extension is crucial to obtain radical resection. Fortunately, the cavernous sinus proper extension is the easier part to remove and pre-existing cranial nerves deficit has good chance of recovery. As chordomas originate and are always present extradurally (prior to invading the dura), an extradural access to chordomas is the natural way for radical resection without brain manipulation. The zygomatic approach is key to the middle fossa, cavernous sinus, petrous apex, and infratemporal fossa; it minimizes the depth of field and is highly advantageous in chordoma located mainly lateral to the cavernous carotid artery.6–12 This article demonstrates the advantages of this approach, including the mobilization of the zygomatic arch alleviating temporal lobe retraction, the peeling of the middle fossa dura for exposure of the cavernous sinus, the safe dissection of the trigeminal and oculomotor nerves, and total control of the petrous and cavernous carotid artery. Tumor extensions to the sphenoid sinus, sella, petrous apex, and clivus can be removed. The patient is a 30-yr-old who consented for surgery.

Endoscopic transorbital approach to the infratemporal fossa and parapharyngeal space: a cadaveric study

2020 ◽  
Vol 133 (6) ◽  
pp. 1948-1959 ◽  
Author(s):  
Mina M. Gerges ◽  
Saniya S. Godil ◽  
Iyan Younus ◽  
Michael Rezk ◽  
Theodore H. Schwartz
Keyword(s):  
Carotid Artery ◽  
Parapharyngeal Space ◽  
Infratemporal Fossa ◽  
Middle Meningeal Artery ◽  
Endoscopic Approach ◽  
Surgical Approaches ◽  
Maxillary Artery ◽  
Lateral Pterygoid Muscle ◽  
Endoscopic Techniques ◽  
Endoscopic Transorbital

OBJECTIVEThe infratemporal fossa (ITF) and parapharyngeal space are anatomical regions that can be challenging to access without the use of complex, cosmetically disfiguring approaches. With advances in endoscopic techniques, a new group of surgical approaches to access the intracranial space through the orbit has been recently referred to as transorbital neuroendoscopic surgery (TONES). The objective of this study was to establish a transorbital endoscopic approach utilizing the inferior orbital fissure (IOF) to gain access to the ITF and parapharyngeal space and provide a detailed endoscopic anatomical description of this approach.METHODSFour cadaveric heads (8 sides) were dissected using a TONES approach through the IOF to reach the ITF and parapharyngeal space, providing stepwise dissection with detailed anatomical findings and a description of each step.RESULTSAn inferior eyelid approach was made with subperiosteal periorbital dissection to the IOF. The zygomatic and greater wing of the sphenoid were drilled, forming the boundaries of the IOF. The upper head of the lateral pterygoid muscle in the ITF and parapharyngeal space was removed, and 7 distinct planes were described, each with its own anatomical contents. The second part of the maxillary artery was mainly found in plane 1 between the temporalis laterally and the lateral pterygoid muscle in plane 2. The branches of the mandibular nerve (V3) and middle meningeal artery (MMA) were identified in plane 3. Plane 4 was formed by the fascia of the medial pterygoid muscle (MTM) and the tensor veli palatini muscle. The prestyloid segment, found in plane 5, was composed mainly of fat and lymph nodes. The parapharyngeal carotid artery in the poststyloid segment, found in plane 7, was identified after laterally dissecting the styloid diaphragm, found in plane 6. V3 and the origin of the levator and tensor veli palatini muscles serve as landmarks for identification of the parapharyngeal carotid artery.CONCLUSIONSThe transorbital endoscopic approach provides excellent access to the ITF and parapharyngeal space compared to previously described complex and morbid transfacial or transcranial approaches. Using the IOF is an important and useful landmark that permits a wide exposure.

scholarly journals Surgical approaches for resection of vestibular schwannomas: translabyrinthine, retrosigmoid, and middle fossa approaches

2012 ◽  
Vol 33 (3) ◽  
pp. E9 ◽  
Author(s):  
Roukoz Chamoun ◽  
Joel MacDonald ◽  
Clough Shelton ◽  
William T. Couldwell
Keyword(s):  
Surgical Techniques ◽  
Vestibular Schwannomas ◽  
Treatment Modalities ◽  
Surgical Approaches ◽  
Surgical Removal ◽  
Team Approach ◽  
Middle Fossa ◽  
Optimal Outcome

Surgical removal remains one of the key treatment modalities for vestibular schwannomas. A team approach between a neurotologist and a neurosurgeon offers the patient the expertise of both specialties and maximizes the chances for an optimal outcome. Vestibular schwannomas can typically be resected through 1 of 3 main surgical approaches: the translabyrinthine, the retrosigmoid, or the middle fossa approaches. In this report and videos, the authors describe and illustrate the indications and surgical techniques for the removal of these tumors.

Surgical management and outcome of schwannomas in the craniocervical region

2011 ◽  
Vol 114 (5) ◽  
pp. 1257-1267 ◽  
Author(s):  
Daniel D. Cavalcanti ◽  
Nikolay L. Martirosyan ◽  
Ketan Verma ◽  
Sam Safavi-Abbasi ◽  
Randall W. Porter ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Surgical Management ◽  
Clinical Presentation ◽  
Early Recognition ◽  
Cranial Nerves ◽  
Surgical Approaches ◽  
Motor Deficits ◽  
Tumor Control ◽  
Surgical Removal ◽  
Far Lateral Approach

Object Schwannomas occupying the craniocervical junction (CCJ) are rare and usually originate from the jugular foramen, hypoglossal nerves, and C-1 and C-2 nerves. Although they may have different origins, they may share the same symptoms, surgical approaches, and complications. An extension of these lesions along the posterior fossa cisterns, foramina, and spinal canal—usually involving various cranial nerves (CNs) and the vertebral and cerebellar arteries—poses a surgical challenge. The primary goals of both surgical and radiosurgical management of schwannomas in the CCJ are the preservation and restoration of function of the lower CNs, and of hearing and facial nerve function. The origins of schwannomas in the CCJ and their clinical presentation, surgical management, adjuvant stereotactic radiosurgery, and outcomes in 36 patients treated at Barrow Neurological Institute (BNI) are presented. Methods Between 1989 and 2009, 36 patients (mean age 43.6 years, range 17–68 years) with craniocervical schwannomas underwent surgical resection at BNI. The records were reviewed retrospectively regarding clinical presentation, radiographic assessment, surgical approaches, adjuvant therapies, and follow-up outcomes. Results Headache or neck pain was present in 72.2% of patients. Cranial nerve impairments, mainly involving the vagus nerve, were present in 14 patients (38.9%). Motor deficits were found in 27.8% of the patients. Sixteen tumors were intra- and extradural, 15 were intradural, and 5 were extradural. Gross-total resection was achieved in 25 patients (69.4%). Adjunctive radiosurgery was used in the management of residual tumor in 8 patients; tumor control was ultimately obtained in all cases. Conclusions Surgical removal, which is the treatment of choice, is curative when schwannomas in the CCJ are excised completely. The far-lateral approach and its variations are our preferred approaches for managing these lesions. Most common complications involve deficits of the lower CNs, and their early recognition and rehabilitation are needed. Stereotactic radiosurgery, an important tool for the management of these tumors as adjuvant therapy, can help decrease morbidity rates.

scholarly journals Anatomical Basis of the Zygomatic-Transmandibular Approach: Operative Video

2021 ◽  
Author(s):  
Gerardo Guinto ◽  
Eli Hernandez ◽  
David Gallardo-Ceja ◽  
Francisco Gallegos-Hernandez ◽  
Norma Arechiga ◽  
...  
Keyword(s):  
Parapharyngeal Space ◽  
Infratemporal Fossa ◽  
Clinical Manifestations ◽  
Middle Fossa ◽  
Facial Nerve Function ◽  
Trigeminal Schwannoma ◽  
Anatomical Basis ◽  
Transmandibular Approach ◽  
Neurovascular Structures ◽  
Surgical Option

AbstractTumor growth in infratemporal fossa (ITF) and parapharyngeal space (PPS) is generally slow and generates very few clinical manifestations, so it is not uncommon for tumors to reach large dimensions at the time of diagnosis, making necessary to perform ample approaches. In zygomatic-transmandibular approach (ZTMA), the access of the ITF and PPS is obtained by a combination of a pterional craniotomy plus a zygomatic-mandibular osteotomy. Tumor excision is achieved by its initial dissection from all of the neurovascular structures of the middle fossa by the neurosurgical team and the final resection by the head and neck team from below. In the first part of this video, we present a brief anatomical–surgical description of the ITF and PPS and in the second part, we show case of a trigeminal schwannoma that could be successfully removed through a ZTMA. Using this approach, an ample and safe exposure of the ITF and PPS is achieved, without affecting the chewing or facial nerve function and with excellent cosmetic results, so it can be considered as a reliable surgical option, particularly in cases of giant tumors that affect these regions (Figs. 1 and 2).The link to the video can be found at: https://youtu.be/oxVFhzT8HsQ.

scholarly journals Minimally Invasive Surgery for Resection of Parapharyngeal Space Tumors

2017 ◽  
Vol 79 (03) ◽  
pp. 250-256 ◽  
Author(s):  
Irit Duek ◽  
Gill Sviri ◽  
Salem Billan ◽  
Ziv Gil
Keyword(s):  
Parapharyngeal Space ◽  
Malignant Tumors ◽  
Infratemporal Fossa ◽  
Outcome Data ◽  
Surgical Removal ◽  
Vascular Control ◽  
Transcervical Approach ◽  
Parapharyngeal Space Tumors ◽  
Complex Anatomy ◽  
Complete Tumor

Background Surgical removal of parapharyngeal space tumors (PPST) poses challenges due to the complex anatomy of the region. PPSTs are routinely resected by a transcervical approach using blind finger dissection. Large PPSTs or those located high at the skull base, often require transmandibular or infratemporal fossa approaches, associated with considerable morbidity. Objective Here, we describe an approach for PPST removal that comprises transcervical endoscopic, with or without transoral robotic technique. Materials and Methods We retrospectively studied the demographic, clinical, surgical, and outcome data of 11 consecutive patients who underwent PPST excision between June 2013 and July 2017 at our center. Patients either underwent a transcervical endoscopic procedure (n = 4), a transoral robotic procedure (n = 2) or a combination of the two procedures (n = 5). Results Complete tumor excision was achieved in all cases, with no intra-, peri-, or postoperative complications. Final histopathologic findings demonstrated pleomorphic adenoma for seven patients, cavernous hemangioma for one patient, and malignant tumors for three patients. The average tumor size was 44.22 ± 31.9 cm3 (range: 7.5–111 cm3). At follow-up (range: 3–42 months), there was no evidence of recurrence. Conclusions The approach described provides improved visualization and safe vascular control with minimum tumor stress, preventing the need for blind finger dissection, and allowing complete tumor removal while minimizing tumor spillage, nerve injury, and blood loss, maintaining excellent cosmetic and functional results. This approach could be utilized for the removal of large benign PPST, or small PPST located high.

Standardised method of selecting surgical approaches to benign parapharyngeal space tumours, based on pre-operative images

2007 ◽  
Vol 122 (6) ◽  
pp. 628-634 ◽  
Author(s):  
S Kanzaki ◽  
H Nameki
Keyword(s):  
Surgical Approach ◽  
Parapharyngeal Space ◽  
Surgical Approaches ◽  
Anatomical Landmarks ◽  
Resonance Imaging ◽  
Large Tumour ◽  
Transcervical Approach ◽  
Skull Base Approach ◽  
Inferior Portion ◽  
Superior Portion

AbstractMany approaches to the parapharyngeal space have been reported. However, few reports describe parapharyngeal space tumours and the best surgical approach to these tumours. We retrospectively examined the surgical approaches we used to resect 22 parapharyngeal space tumours. In order to determine the best surgical approach for each tumour, we first subdivided the parapharyngeal space into six compartments, based on anatomical landmarks seen on computed tomography and/or magnetic resonance imaging scans. We then determined the location of each tumour relative to these six parapharyngeal space compartments. In our series of cases, we found that large tumours spanning the superior portion of the parapharyngeal space could be completely removed through a skull base approach. To remove a large tumour in the middle and inferior portion of the parapharyngeal space, a transparotid approach was the most suitable. Finally, a tumour in the inferior portion of the parapharyngeal space was best accessed through a transcervical approach.

Surgical removal of giant acoustic neurinomas involving the skull base

1989 ◽  
Vol 71 (4) ◽  
pp. 611-615 ◽  
Author(s):  
Yutaka Sawamura ◽  
Yoku Nakagawa ◽  
Toshio Ikota ◽  
Hiroshi Abe
Keyword(s):  
Skull Base ◽  
Temporal Bone ◽  
Infratemporal Fossa ◽  
Cranial Nerves ◽  
Internal Auditory Canal ◽  
Petrous Bone ◽  
Neurological Deficits ◽  
Surgical Removal ◽  
Sphenoidal Sinus ◽  
Content Type

✓ Neurinomas arising from the peripheral branch of the acoustic nerve distal to the internal auditory canal in the temporal bone are rare. Two advanced skull-base neurinomas are described which were situated mainly in the temporal petrous bone, and extended to the parapharyngeal space anteriorly, to the lateral cervical portion inferiorly, into the sphenoidal sinus medially, and into the middle and posterior cranial fossae compressing the brain stem. Both patients had been deaf for several years without other neurological deficits. The operative findings revealed that the fifth, seventh, and caudal cranial nerves were intact; therefore, it was suspected that these neurinomas originated primarily within the cochlea or the vestibule in the temporal bone. The tumors were completely removed via an extradural approach, with good results. Since the surgical treatment of such advanced skull-base neurinomas is difficult, the operative infratemporal fossa approach is described in detail.

Transmandibular Transpterygoid Approach to the Nasopharynx, Parapharyngeal Space, and Skull Base

1992 ◽  
Vol 101 (5) ◽  
pp. 383-389 ◽  
Author(s):  
Eiji Yumoto ◽  
Hiroshi Okamura ◽  
Naoaki Yanagihara
Keyword(s):  
Skull Base ◽  
Parapharyngeal Space ◽  
Cranial Nerves ◽  
Practical Method ◽  
Jugular Foramen ◽  
Primary Site ◽  
Surgical Removal ◽  
Benign Neoplasms ◽  
Operative Field ◽  
Neoplastic Lesions

The nasopharynx, upper part of the parapharyngeal space, and skull base are relatively inaccessible to the surgeon without major postoperative complications. Operative fields reached by conventional approaches through the palate and maxillary sinus are too limited and narrow to remove extensive tumors. The authors applied a transmandibular transpterygoid approach for the removal of five residual nasopharyngeal carcinomas (NPCs) after full doses of irradiation, one pleomorphic adenoma of the nasopharynx, and one large parapharyngeal schwannoma extending into the jugular foramen. This approach offers a wide operative field so that large blood vessels and cranial nerves can be managed easily. All tumors were successfully resected. Two patients with benign neoplasms had uneventful recoveries after treatment. Of five patients with NPC, two are alive with no evidence of disease for 68 months and 50 months, respectively, while two died of metastases to the liver and bones. The other patient is alive with metastases in the lungs. No tumor recurred in the local primary site, however. Since the number of NPC cases is small, the usefulness of surgical removal of the postirradiation residual NPC is not clear. Our experience proved that the transmandibular transpterygoid approach is a practical method in the treatment of neoplastic lesions in the nasopharynx, parapharyngeal space, and skull base.

scholarly journals Cavernous Sinus Chondromas

2018 ◽  
Vol 26 (3) ◽  
pp. 211-217
Author(s):  
Jonathan Polo Valdez ◽  
Ricardo Ramina ◽  
Luis Fernando Moura Da Silva Jr ◽  
Mauricio Coelho Neto
Keyword(s):  
Cavernous Sinus ◽  
Clinical Symptoms ◽  
Tumor Resection ◽  
Cranial Nerves ◽  
The Body ◽  
Neurological Deficits ◽  
Surgical Approaches ◽  
Benign Tumors ◽  
Surgical Removal ◽  
Adequate Knowledge

Background: Chondromas are benign tumors with slow growth pattern that may develop along the body. Intracranial chondromas are rare, 0.1 to 0.3% of all intracranial tumors, usually in parasellar region. Few papers reported cavernous sinus chordomas. Case Description: We reported two cases of cavernous sinus chondromas. Two patients presented diplopia, one facial hypoesthesia and one presented extension to the petroclival region. Surgical approaches were frontotemporal combining presigmoid/middle fossa. Literature was reviewed concerning incidence, clinical symptoms, treatment and outcome. Both cases achieved complete tumor resection without postoperative complication. Preoperative deficits improved. Literature review confirms their rarity, clinical symptoms are related to deficits of cranial nerves passing through the cavernous sinus and cure can be achieved through radical surgical removal. Conclusion: Cavernous sinus chondromas are rare benign lesions with insidious growth. Adequate knowledge of cavernous sinus anatomy, microsurgical experience, intraoperative monitoring of cranial nerves and neuronavigation allows radical tumor removal with no additional neurological deficits.

Sign in / Sign up

Export Citation Format

Share Document