Transzygomatic pterional approach. Part 2: Surgical experience in the management of skull base pathology

Objectives: To present our experience with the transzygomatic pterional approach in the treatment of neurosurgical pathology of the base of the skull located in the middle cranial fossa and surrounding areas. Method: A retrospective study of pathological findings, surgical outcomes and complications in a series of 31 cases operated on between 2009 and 2011 using a transzygomatic pterional approach. Results: The lesions involved the sphenoid wing (25.9%), several regions due to invasive growth pattern (19.5%), the temporal lobe (16.1%) and cavernous sinus (12.9%). The others were located in the floor of the middle fossa, Meckel's cave, incisural space, cisterns and infratemporal region. The pathological nature of the lesions was: benign meningioma (42%), temporal lobe tumour (19.5%), vascular disease (12.9%), inflammatory lesions (6.4%), atypical meningioma (6.4%), epidermoid cyst (6.4%), neurinoma (3.2%) and poorly differentiated infratemporal carcinoma (3.2%). The approach was usually combined extra-intradural (58.1%) and, less frequently, just extradural (16.1%) or intradural (25.8%). Approach-related complications were minor: haematomas in the wound not requiring treatment (67.8%), superior transient facial paresis (9.7%), transient temporomandibular joint dysfunction (12.9%) and atrophy of the temporal muscle (16.2%). There were no hardware-related complications or cosmetic issues related to the osteotomy and posterior osteosynthesis of the zygomatic arch. Conclusions: The pterional approach combined with osteotomy of the zygomatic arch allows mobilising the temporalis muscle away from the temporal fossa, consequently exposing its entire surface to complete the temporal craniotomy up to the middle fossa; it helps to access and treat pathology in this region or it can be used as a corridor to approach surrounding areas. (C) 2011 Sociedad Espanola de Neurocirugia. Published by Elsevier Espana, S.L. All rights reserved.