gms | German Medical Science

Objective: The classic neurotology approach to the infratemporal fossa includes a more or less extended petrosectomy. The neurosurgical approach preserves the petrous bone and has a more anterior trajectory. The aim is to describe the experience with the preauricular approach centered to the space between the roots of the zygoma.

Methods: Ten patients were operated on tumors extending into the infratemporal fossa. A temporal craniotomy alone was performed in five cases. In four cases an osteotomy of the zygoma was added. An orbitozygomatic osteotomy was added in one case. The tumor entities included two meningiomas, two neurinomas, one hemangiopericytoma, one juvenile angiofibroma, one giant cell tumor, two adenoidcystic carcinomas, and one osteosarcoma. Duraplasty was formed in 7/10 cases.

Results: A temporal craniotomy alone without osteotomy was applied, if a large part of the tumor was found intracranially. An osteotomy of the zygoma allowed the dislocation of the temporal muscle, reducing the need for temporal lobe retraction. Therefore this osteotomy was applied in cases without a large intracranial tumor mass. The orbitozygomatic osteotomy was performed with the idea to minimize the need for temporal lobe retraction, which was not obtained in the present case. The infratemporal fossa part of the tumors were predominantly resected via the lateral loop (space between foramen rotundum and ovale). Extended drilling may lead into the sphenoid and maxillary sinus as well as into the posterior infratemporal fossa. Gross total resection was achieved in the meningioma, neurinoma, giant cell tumor, and adenoicystic carcinoma cases. As intended, a partial resection was achieved in the juvenile angiofibroma case. In the osteosarcoma case, a tumor remnant was found in the sphenoid sinus. One csf leak stopped after four days of lumbar drainage without revision surgery.

Conclusions: Preauricular skin incision followed by temporal craniotomy combined with craniectomy of the temporal base between foramen rotundum and ovale is a suitable approach for tumors of the temporal base extending into the infratemporal fossa. Zygomatic osteotomy to dislocate the temporal muscle bulk lateral and basal should be considered liberally to minimize the need for temporal lobe retraction.