Skull Base 2008; 18(1): 017-027
DOI: 10.1055/s-2007-992765
ORIGINAL ARTICLE

© Thieme Medical Publishers

Quantitative Evaluation of Transtemporal and Facial Translocation Approaches to Infratemporal Fossa

Moni A. Kuriakose1 , Alex Sorin2 , Rajeev Sharan1 , Andrew J. Fishman3 , Ramesh Babu3 , Mark D. DeLacure2
  • 1Head and Neck Institute, Amrita Institute of Medical Sciences, Kerala, India
  • 2Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York
  • 3Department of Otolaryngology and Neurotology, New York University School of Medicine, New York, New York
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
13. November 2007 (online)

ABSTRACT

Objective: To compare the extent of exposure and surgical maneuverability provided by facial translocation and transtemporal approaches for access to the infratemporal fossa and anterolateral skull base. Materials and Methods: Surgical procedures were performed on five fresh frozen adult cadavers (ten sides) with no known pathology. Facial transfacial approaches with and without a mandibulotomy and transtemporal approaches were evaluated. Objective measures were (1) the distance from the surgical plane to designated anatomic landmarks and (2) the surgical angle of exposure. Results: Distances from the surgical plane to the anatomic reference points were comparable for most of the access procedures (3 to 6 cm). The extended midfacial translocation and bilateral facial translocation approaches did, however, provide a shorter operative distance (1 to 3 cm) for access to the infratemporal fossa and contralateral structures, respectively. The transtemporal approaches facilitate a better angle of exposure (74 to 84 degrees) to the petrotemporal region, while the transfacial approaches were superior for access to the infratemporal structures. Conclusions: Based on the results, we propose a clinical algorithm for selecting a surgical approach based on the position and extent of an infratemporal or petrotemporal lesion.

REFERENCES

  • 1 Fisch U. Infratemporal fossa approach to tumors of the temporal bone and base of skull.  J Laryngol Otol. 1978;  92 949-967
  • 2 Janecka I P, Sen C N, Sekhar L N, Arriaga M. Facial translocation: a new approach to the cranial base.  Otolaryngol Head Neck Surg. 1990;  103 413-419
  • 3 Janecka I P. Classification of facial translocation approach to the skull base.  Otolaryngol Head Neck Surg. 1995;  112 579-585
  • 4 Bejjani G K, Sullivan B, Salas-Lopez E et al.. Surgical anatomy of the infratemporal fossa: the styloid diaphragm revisited.  Neurosurgery. 1998;  43 842-853
  • 5 Kennedy J D, Haines S J. Review of skull base surgery approaches: with special reference to pediatric patients.  J Neurooncol. 1994;  20 291-312
  • 6 Kumar A, Valvassori G, Jafar J, Mafee M. Skull base lesions: a classification and surgical approaches.  Laryngoscope. 1986;  96 252-263
  • 7 Ruckenstein M J, Denys D. Lateral skull-base surgery: a review of recent advances in surgical approaches.  J Otolaryngol. 1998;  27 46-54
  • 8 Gonzalez L F, Crawford N R, Horgan M A, Deshmukh P, Zabramski J M, Spetzler R F. Working area and angle of attack in three cranial base approaches: pterional, orbitozygomatic and maxillary extension of the orbitozygomatic approach.  Neurosurgery. 2002;  50 550-555
  • 9 Suhardja A S, Cusimano M D, Agur A MR. Surgical exposure and resection of the vertical portion of the petrous internal carotid artery: anatomic study.  Neurosurgery. 2001;  49 665-670
  • 10 Vrionis F D, Cano W G, Heilman C B. Microsurgical anatomy of the infratemporal fossa as viewed laterally and superiorly.  Neurosurgery. 1996;  39 777-786
  • 11 Aziz K MA, Sanan A, van Loveren H R, Tew J M, Keller J T, Pensak M L. Petroclival meningiomas: predictive parameters for transpetrosal approaches.  Neurosurgery. 2000;  47 139-152
  • 12 Arriaga M A. Transtemporal approaches. In: Janecka IP, Tiedemann K Skull Base Surgery: Anatomy, Biology, and Technology. Philadelphia; Lippincott-Raven 1997: 221-242
  • 13 Honeybul S, Neil-Dwyer G, Evans B T, Lang D A. The transzygomatic approach: an anatomic study.  Br J Oral Maxillofac Surg. 1997;  35 334-340
  • 14 Guinto G, Abello J, Molina A et al.. Zygomatic-transmandibular approach for giant tumors of the infratemporal fossa and parapharyngeal space.  Neurosurgery. 1999;  45 1385-1398
  • 15 Honeybul S, Neil-Dwyer G, Lees P D, Evans B T, Lang D A. The orbitozygomatic infratemporal fossa approach: a quantitative anatomical study.  Acta Neurochir (Wien). 1996;  138 255-264
  • 16 Ammirati M, Bernando A. Analytical evaluation of complex anterior approaches to the cranial base: an anatomic study.  Neurosurgery. 1998;  43 1398-1408
  • 17 Fisch U, Pillsbury H C. Infratemporal fossa approach to lesions of the temporal bone and base of skull.  Arch Otolaryngol. 1979;  105 99-108
  • 18 Lello G, Statham P, Steers J, McGurk M. Craniofacial access to the anterior and middle cranial fossae and skull base.  J Craniomaxillofac Surg. 1997;  25 285-293
  • 19 Moore C E, Ross D A, Marentette L J. Critical pathways in anterior cranial base surgery.  Otolaryngol Head Neck Surg. 1999;  121 113-118
  • 20 Schwartz M S, Anderson G J, Horgan M A, Kellogg J X, McMenomey S O, Delshaw Jr J B. Quantification of increased exposure resulting from orbital rim and orbitozygomatic osteotomy via the frontotemporal transsylvian approach.  J Neurosurg. 1999;  91 1020-1026
  • 21 Spektor S, Anderson G J, McMenomey S O, Horgan M A, Kellogg J X, Delshaw Jr J B. Quantitative description of the far-lateral transcondylar transtubercular approach to the foramen magnum and clivus.  J Neurosurg. 2000;  92 824-831
  • 22 Horgan M A, Anderson G J, Kellogg J X et al.. Classification and quantification of the petrosal approach to the petroclival region.  J Neurosurg. 2000;  93 108-112
  • 23 Cantore G, Ciappetta P, Delfini R. Choice of neurosurgical approach in the treatment of cranial base lesions.  Neurosurg Rev. 1994;  17 109-125
  • 24 Day J D. Commentary on: Gonzalez LF, Crawford NR, Horgan MA, Deshmukh P, Zabramski JM, Spetzler RF. Working area and angle of attack in three cranial base approaches: pterional, orbitozygomatic, and maxillary extension of the orbitozygomatic approach.  Neurosurgery. 2002;  50 555-557 discussion 555-557
  • 25 Som P M, Shugar J M, Parisier S C. A clinical-radiographic classification of skull basse lesions.  Laryngoscope. 1979;  89 1066-1076

Moni A KuriakoseM.D. 

Chairman, Head and Neck Institute, Amrita Institute of Medical Sciences

Elamakkara, Cochin, Kerala 682026, India

eMail: mak12@nyu.edu