Zygomatic approach to skull-base lesions

Al‐Mefty, Ossama; Anand, Vinod K.

doi:10.3171/jns.1990.73.5.0668

Cited by 175 publications

(71 citation statements)

References 17 publications

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“…81 The temporal approach in conjunction with petrosectomy was associated with new deterioration of facial nerve function, 19 subdural temporal lobe hemorrhage, and CSF rhinorrhea. 119 Complications associated with the infratemporal alone or in conjunction with mandibular manipulations include wound infections, CSF leakage, 123 temporary restriction of mandibular opening, 1 conductive hearing loss, numbness of the lower lip, temporal depression caused by the use of the temporalis muscle flap, and facial paresis secondary to translocation of the facial nerve. 32,72 Because the effect of mandibular resection in the child is not well known, some authors have recommended avoiding mandibular resection whenever possible.…”

Section: Neurosurgical Approaches To the Middle Cranial Basementioning

confidence: 99%

Tumors of the skull base in children: review of tumor types and management strategies

Tsai¹,

Santoreneos²,

Rutka³

2002

FOC

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Although many treatment strategies for skull base tumors in adults have been reported, relatively little has been reported regarding such therapies in the pediatric population. Skull base tumors in children present a therapeutic challenge because of their unique pathological composition, the constraints of the maturing skull and brain, and the small size of the patients. In this review, the authors examine the pediatric skull base lesions that occur in the anterior, middle, and posterior cranial base, focusing on unique pediatric tumors such as encepahalocele, fibrous dysplasia, esthesioneuroblastoma, craniopharyngioma, juvenile nasopharyngeal angiofibroma, cholesteatoma, chordoma, chondrosarcoma, and Ewing sarcoma. They review management strategies that include radio- and chemotherapy, as well as surgical approaches with emphasis on the modifications and complications associated with the procedures as they apply in children. Evidence for the advantages and limitations of radiotherapy, chemotherapy, and surgery as it pertains to the pediatric population will be examined. With a working knowledge of skull base anatomy and special considerations of the developing craniofacial skeleton, neurosurgeons can treat skull base lesions in children with acceptable morbidity and mortality rates. Outcomes in this population may be better than those in adults, in part because of the benign histopathology that frequently affects the pediatric skull base, as well as the plasticity of the maturing nervous system.

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Section: Neurosurgical Approaches To the Middle Cranial Basementioning

confidence: 99%

Tumors of the skull base in children: review of tumor types and management strategies

Tsai¹,

Santoreneos²,

Rutka³

2002

FOC

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“…Several advantages are associated with this approach: minimal brain retraction, a short distance to the lesions, multidirectional view, and an absence of contamination. 1,3,35,36 In our series, this approach was used in conjunction with the transsphenoidal approach in cases in which there was cavernous sinus invasion and paraclinoid intradural extension, such as in Case 2. The disadvantage of this approach is the limited visualization it provides and the need to remove the extension of the tumor into the skull base bone, which may then require a second approach such as the transsphenoidal or the extended frontal approach.…”

Section: Selection Of Approachesmentioning

confidence: 99%

Surgical approaches and strategies for skull base chordomas

Tamaki

Nagashima²,

Ehara³

et al. 2001

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Object The management of chordomas involving the skull base continues to present a number of treatment-related problems. Recently, both radical resection and charged-particle irradiation or stereotactic radiosurgery have reportedly been found effective for tumor control and for promoting a better quality of life in patients. In this article the authors analyzed the outcomes in 17 patients with skull base chordomas who were surgically treated at Kobe University Hospital between 1972 and 2000. Methods Preoperative radiological examinations included magnetic resonance imaging, computerized tomography, angiography, and balloon occlusion test of the internal carotid artery. Among the various surgical approaches used to remove the tumor were the frontoorbitozygomatic, transmaxillary, transcondylar, transsphenoidal, and the transbasal. Total removal was achieved in two (12%), near-total removal in three (18%), subtotal removal in nine (52%), and partial removal in three patients (18%). Since 1990, chordomas have been radically resected via various skull base approaches; the combined total or near-total removal rate has been 80% in this period. Radical removal of the tumors has not led to an increased risk. At the final follow-up review (mean 59.5 month), 75% of the patients were still alive, and 25% had died of chordoma recurrence. The overall recurrence-free survival rate was 82% at 3 years and 51% at 5 years. The 5-year recurrence-free survival rate in the five patients who underwent the operation during the past decade was 77% (mean follow up of 5.2 years). In two patients with recurrent tumors who underwent radiosurgery, no evidence of tumor regrowth was demonstrated at 3 years posttreatment. Conclusions The authors suggest that for the treatment of skull base chordomas radical resection is a key factor for longer survival and improved quality of life. Patients with sufficiently small tumors, which show a favorable configuration and location, can be suitable candidates for stereotactic radiosurgery.

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“…Some other new techniques are also used to approach the orbit, anterior fossa and skull base [4][5][6][7][8][9] .…”

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confidence: 99%

Supraorbital eyebrow approach to skull base lesions

Fernandes

Maitrot

Kehrli

et al. 2002

Arq. Neuro-Psiquiatr.

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-We report our experience with a supraorbital eyebrow minicraniotomy. This technique is suitable to lesions situated in the region of the anterior fossa, suprasellar cisterns, parasellar region and Sylvian fissure. A 50 mm incision in the eyebrow and a supraorbital minicraniotomy is performed. Sixteem patients harboring different lesions were operated on with good postoperative and cosmetic results. We conclude that this approach is safe and useful in selected cases.KEY WORDS: tumor, aneurysm, skull base, minimally invasive, surgical approach.Abordagem supra-orbitária superciliar de lesões da base do crânio RESUMO -Reportamos nossa experiência com o uso de uma minicraniotomia supra-orbitária através do supercílio para tratamento de lesões situadas na fossa anterior, cisterna supra-selar, para-selar e fissura de Sylvius. Uma incisão de 50 mm é realizada no supercílio, seguida de minicraniotomia. Dezesseis pacientes portadores de diferentes lesões foram operados e apresentaram bom resultado pós-operatório e também estético. Concluímos que esse acesso é seguro e útil em casos selecionados PALAVRAS-CHAVE: tumor, aneurisma, base do crânio, abordagem minimamente invasiva, acesso cirúrgico. Usually tumors, aneurysms, and other lesions situated in the anterior or middle cranial fossae are approached by the standard classic pterional craniotomy [1][2][3] . Some other new techniques are also used to approach the orbit, anterior fossa and skull base 4-9 .Recently Perneczky et al. [10][11][12] have developed several supraorbital endoscopic "key-hole" approaches and demonstrated a good visualization of the socalled "suprasellar virtual pyramid". Combination of endoscopy and microneurosurgery permits the reduction of the size of the craniotomy required for good visualization of tumor or aneurysm and surrounding structures if compared to traditional techniques. We report our experience with a supraorbital eyebrow approach. We add to the description of our 16 cases some details on important landmarks. These landmarks are useful to preserve the frontotemporal branch of the facial nerve, the supraorbital and supratrochlear nerves in order to prevent cosmetic sequela of this easy and time-sparing procedure.

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Zygomatic approach to skull-base lesions

Cited by 175 publications

References 17 publications

Tumors of the skull base in children: review of tumor types and management strategies

Tumors of the skull base in children: review of tumor types and management strategies

Surgical approaches and strategies for skull base chordomas

Supraorbital eyebrow approach to skull base lesions

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