Zygomatic-transmandibular approach for giant tumors of the infratemporal fossa and parapharyngeal space

被引:38
作者
Guinto, G
Abello, J
Molina, A
Gallegos, F
Oviedo, A
Nettel, B
López, R
机构
[1] Ctr Med Nacl Siglo 21, Dept Neurosurg, Mexico City, DF, Mexico
[2] Ctr Med Nacl Siglo 21, Dept Head & Neck Surg, Mexico City, DF, Mexico
[3] Ctr Med Nacl Siglo 21, Dept Maxillofacial Surg, Mexico City, DF, Mexico
关键词
anatomic landmarks; cranial base surgery; cranial base tumor; infratemporal fossa; malignant disease; parapharyngeal space; skull base surgery; skull base tumor;
D O I
10.1097/00006123-199912000-00025
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
OBJECTIVE: The surgical anatomy of the infratemporal fossa and parapharyngeal space is often not properly understood by neurosurgeons, because these areas are more related to other medical disciplines. This article provides a detailed description of the infratemporal fossa and parapharyngeal space anatomy in cadaveric specimens and offers a neurosurgical perspective on a surgical approach that allows wide exposure and complete resection of giant tumors in this location. METHODS: Ten cadaveric specimens were prepared for anatomic study. Dissections were performed to emphasize the relationship between bone, muscles, and neurovascular structures and to simultaneously expose the middle cranial fossa, the infratemporal fossa, and the parapharyngeal space. Ten patients with giant lesions in these areas (with maximum tumor diameter >8 cm) were treated via this approach. RESULTS: The main obstacles to approaching the infratemporal fossa and the parapharyngeal space are the zygomatic arch, the parotid gland, the facial nerve, and the ascending ramus of the mandible. Thus, by combining a pterional-zygomatic craniotomy with transmandibular access, working up and down the parotid gland, the exposure is wider and safer. Among the in patients treated, tumors were totally resected in 7, subtotally resected in 2, and partially resected in 1. Morbidity was unremarkable, and, in 8 patients, clinical status improved dramatically. CONCLUSION: The zygomatic-transmandibular approach allows resection of giant lesions in the middle cranial base, when they are invading the infratemporal fossa and parapharyngeal space, with a low morbidity rate.
引用
收藏
页码:1385 / 1398
页数:14
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