COMBINED MIDDLE CRANIAL FOSSA AND INFRATEMPORAL FOSSA APPROACH FOR REMOVAL OF TUMORS IN THE HIGH PARAPHARYNGEAL SPACE AND PTERYGOPALATINE FOSSA

Functional paraganglioma is a rare tumor that secretes the catecholamine which is able to cause secondary hypertension. Surgical resection is the only curative treatment modality for this tumor, which can correct the secondary hypertension. The pterygopalatine fossa is a small retromaxillary space which contains a neurovascular bundle that crosses the middle cranial fossa to the nasal cavity, nasal septum, and oral cavity. To our knowledge, two cases have been reported for functional paraganglioma involving the pterygopalatine fossa removed by surgery. We present a patient who had a catecholamine-secreting paraganglioma in the pterygopalatine fossa, which is the first case successfully resected with an endoscopic approach.

Download Full-text

Pediatric multicompartmental trigeminal schwannoma: illustrative case

Journal of Neurosurgery: Case Lessons ◽

10.3171/case2171 ◽

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.

Download Full-text

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

Philippine Journal of Otolaryngology Head and Neck Surgery ◽

10.32412/pjohns.v25i1.651 ◽

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

Download Full-text

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

Journal of Neurosurgery ◽

10.3171/2017.8.jns171308 ◽

2018 ◽

Vol 130 (1) ◽

pp. 227-237 ◽

Cited By ~ 9

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.

Download Full-text

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

Journal of Neurosurgery ◽

10.3171/2012.7.jns11730 ◽

2012 ◽

Vol 117 (4) ◽

pp. 690-696 ◽

Cited By ~ 17

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.

Download Full-text

Orbital, Middle Cranial Fossa, and Pterygopalatine Fossa Yolk Sac Tumor in an Infant

Ophthalmic Plastic and Reconstructive Surgery ◽

10.1097/01.iop.0000144787.69694.94 ◽

2004 ◽

Vol 20 (6) ◽

pp. 469-471 ◽

Cited By ~ 10

Author(s):

Laryssa R. Dragan ◽

Elsa Aghaian ◽

Robin Vora ◽

Grace E. Kim ◽

Stuart R. Seiff

Keyword(s):

Middle Cranial Fossa ◽

Yolk Sac ◽

Pterygopalatine Fossa ◽

Yolk Sac Tumor ◽

Cranial Fossa

Download Full-text

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

Journal of Craniofacial Surgery ◽

10.1097/scs.0b013e3182564a87 ◽

2012 ◽

Vol 23 (4) ◽

pp. e334-e336 ◽

Cited By ~ 1

Author(s):

Tao Yang ◽

Li Zhang ◽

Haihong Bao ◽

Zequan Hua

Keyword(s):

Infratemporal Fossa ◽

Middle Cranial Fossa ◽

Epidermal Cyst ◽

Cranial Fossa

Download Full-text

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

Journal of Neurosurgery ◽

10.3171/jns.1988.68.5.0678 ◽

1988 ◽

Vol 68 (5) ◽

pp. 678-683 ◽

Cited By ~ 57

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.

Download Full-text

Endoscopic transnasal transmaxillary approach to the upper parapharyngeal space and the skull base

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-019-05761-6 ◽

2019 ◽

Vol 277 (3) ◽

pp. 801-807

Author(s):

Quan Liu ◽

Huan Wang ◽

Weidong Zhao ◽

Xiaole Song ◽

Xicai Sun ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Skull Base ◽

Internal Carotid ◽

Parapharyngeal Space ◽

Middle Cranial Fossa ◽

Anatomical Landmarks ◽

Endoscopic Endonasal ◽

Cranial Fossa ◽

Optimal Approach

Abstract Purpose Treatment of tumors arising in the upper parapharyngeal space (PPS) or the floor of the middle cranial fossa is challenging. This study aims to present anatomical landmarks for a combined endoscopic transnasal and anterior transmaxillary approach to the upper PPS and the floor of the middle cranial fossa and to further evaluate their clinical application. Methods Dissection of the upper PPS using a combined endoscopic endonasal transpterygoid and anterior transmaxillary approach was performed in six cadaveric heads. Surgical landmarks associated with the approach were defined. The defined approach was applied in patients with tumors involving the upper PPS. Results The medial pterygoid muscle, tensor veli palatini muscle and levator veli palatini muscle were key landmarks of the approach into the upper PPS. The lateral pterygoid plate, foramen ovale and mandibular nerve were important anatomical landmarks for exposing the parapharyngeal segment of the internal carotid artery through a combined endoscopic transnasal and anterior transmaxillary approach. The combined approach provided a better view of the upper PPS and middle skull base, allowing for effective bimanual techniques and bleeding control. Application of the anterior transmaxillary approach also provided a better view of the inferior limits of the upper PPS and facilitated control of the internal carotid artery. Conclusions Improving the knowledge of the endoscopic anatomy of the upper PPS allowed us to achieve an optimal approach to tumors arising in the upper PPS. The combined endoscopic transnasal and anterior transmaxillary approach is a minimally invasive alternative approach to the upper PPS.

Download Full-text