Revising the Indications of Transtemporal Surgical Approaches in the Modern Endoscopic Era of Skull Base Surgery: A Dying Art

Abstract

Objectives The aim of the study is to emphasize and explore the possible transtemporal approaches for spectrum of complicated lateral skull base pathologies.

Design Retrospective analysis of complicated lateral skull base pathologies was managed in our institute between January 2017 and December 2019.

Setting The study was conducted in a tertiary care referral center.

Main Outcome Measures The study focused on the selection of approach based on site and extent of the pathology, the surgical nuances for each approach, and the associated complications.

Results A total of 10 different pathologies of the lateral skull base were managed by different transtemporal approaches. The most common complication encountered was facial nerve palsy (43%, n = 6). Other complications included cerebrospinal fluid (CSF) collection (15%, n = 2), cosmetic deformity (24%, n = 4), petrous internal carotid artery injury (7%, n = 1), and hypoglossal nerve palsy (7%, n = 1). The cosmetic deformity included flap necrosis (n = 2) and postoperative bony defects leading to contour defects of the scalp (n = 2).

Conclusion Surgical approach should be tailored based on the individual basis, to obtain adequate exposure and complete excision. Selection of appropriate surgical approach should also be based on the training and preference of the operating surgeon. Whenever necessary, combined surgical approaches facilitating full tumor exposure are recommended so that complete tumor excision is feasible. This requires a multidisciplinary team comprising neurosurgeons, neuro-otologist, neuroanesthetist, and plastic surgeons. The surgeon must know precise microsurgical anatomy to preserve the adjacent nerves and vessels, which is necessary for better surgical outcomes.

Keywords

transtemporal approaches - lateral skull base - temporal bone

Publication History

Received: 17 April 2020

Accepted: 25 August 2020

Article published online:
26 November 2020

• References

• 1 Zanoletti E, Martini A, Emanuelli E, Mazzoni A. Lateral approaches to the skull base. Acta Otorhinolaryngol Ital 2012; 32 (05) 281-287
• 2 Rhoton Jr AL. The temporal bone and transtemporal approaches. Neurosurgery 2000; 47 (Suppl. 03) S211-S265
• 3 House WF, Hitselberger WE. The transcochlear approach to the skull base. Arch Otolaryngol 1976; 102 (06) 334-342
• 4 Sanna M, Mazzoni A, Saleh E, Taibah A, Mancini F. The system of the modified transcochlear approach: a lateral avenue to the central skull base. Am J Otol 1998; 19 (01) 88-97 , discussion 97–98
• 5 House WF. Surgical exposure of the internal auditory canal and its contents through the middle, cranial fossa. Laryngoscope 1961; 71 (11) 1363-1385
• 6 House WF, Shelton C. Middle fossa approach for acoustic tumor removal. 1992. Neurosurg Clin N Am 2008; 19 (02) 279-288 , vi
• 7 Sekhar LN, Schramm Jr VL, Jones NF. Subtemporal-preauricular infratemporal fossa approach to large lateral and posterior cranial base neoplasms. J Neurosurg 1987; 67 (04) 488-499
• 8 Fisch U, Fagan P, Valavanis A. The infratemporal fossa approach for the lateral skull base. Otolaryngol Clin North Am 1984; 17 (03) 513-552
• 9 Nutik SL, Korol HW. Cerebrospinal fluid leak after acoustic neuroma surgery. Surg Neurol 1995; 43 (06) 553-556 , discussion 556–557
• 10 Jen A, Sanelli PC, Banthia V, Victor JD, Selesnick SH. Relationship of petrous temporal bone pneumatization to the eustachian tube lumen. Laryngoscope 2004; 114 (04) 656-660
• 11 Thomas B, Purkayastha S, Vattoth S, Gupta AK. CT cisternography of paradoxical cerebrospinal fluid rhinorrhea after operation for acoustic neuroma. Riv Neuroradiol 2005; 18 (5–6): 555-558
• 12 Piccirillo E, Agarwal M, , Rohit, Khrais T, Sanna M. Management of temporal bone hemangiomas. Ann Otol Rhinol Laryngol 2004; 113 (06) 431-437
• 13 Friedman O, Neff BA, Willcox TO, Kenyon LC, Sataloff RT. Temporal bone hemangiomas involving the facial nerve. Otol Neurotol 2002; 23 (05) 760-766
• 14 Razek AA, Huang BY. Lesions of the petrous apex: classification and findings at CT and MR imaging. Radiographics 2012; 32 (01) 151-173
• 15 Gelderblom H, Hogendoorn PCW, Dijkstra SD. et al. The clinical approach towards chondrosarcoma. Oncologist 2008; 13 (03) 320-329
• 16 Banaz F, Edem I, Moldovan ID, Kilty S, Jansen G, Alkherayf F. Chondrosarcoma in the petrous apex: case report and review. J Neurol Surg Rep 2018; 79 (04) e83-e87
• 17 Bloch OG, Jian BJ, Yang I. et al. A systematic review of intracranial chondrosarcoma and survival. J Clin Neurosci 2009; 16 (12) 1547-1551
• 18 Lustig LR, Holliday MJ, McCarthy EF, Nager GT. Fibrous dysplasia involving the skull base and temporal bone. Arch Otolaryngol Head Neck Surg 2001; 127 (10) 1239-1247
• 19 Baku M, Ueda H. A rare case of middle ear adenoma. Nagoya J Med Sci 2014; 76 (3-4): 355-360
• 20 Vrionis FD, Aghayev KV, Gardner G, Robertson JH, Brodkey JA. Transtemporal approaches to posterior cranial fossa. In: Alfredo QH. ed. Schmidek and Sweet Operative Neurosurgical Techniques: Indications, Methods, and Results. Philadelphia, PA: Elsevier; 2012: 565-580
• 21 Neal MJ, Meghan NW, danial WN. Surgical approaches to the infratemporal fossa. In: Eugene NM, Carl HS. eds. Operative Otolaryngology Head and Neck Surgery. Philadelphia, PA: Elsevier; 2008: 809-819
• 22 Katsuta T, Rhoton Jr AL, Matsushima T. The jugular foramen: microsurgical anatomy and operative approaches. Neurosurgery 1997; 41 (01) 149-201 , discussion 201–202
• 23 Thakar A, Sikka K, Verma R, Preetam C. Cricothyroid approximation for voice and swallowing rehabilitation of high vagal paralysis secondary to skull base neoplasms. Eur Arch Otorhinolaryngol 2011; 268 (11) 1611-1616