Infratemporal Fossa Approach for Lesions in the Temporal Bone and Base of the Skull

2015 ◽  
pp. 254-266 ◽  
Author(s):  
U. Fisch
Keyword(s):  
Temporal Bone ◽  
Infratemporal Fossa ◽  
Base Of The Skull

scholarly journals Giant Cell Tumour of Temporal Bone and Infratemporal Fossa: A Rare Case

2019 ◽  
Vol 14 (2) ◽  
pp. 503-506
Author(s):  
Avani Jain ◽  
Ishwar Singh ◽  
Ravi Shankar ◽  
Deepti Varshney
Keyword(s):  
Giant Cell ◽  
Temporal Bone ◽  
Rare Case ◽  
Giant Cell Tumour ◽  
Infratemporal Fossa ◽  
Cell Tumour

Auricular Complications in Parotid, Temporal Bone, Infratemporal Fossa, and Lateral Skull Base Surgery

2017 ◽  
Vol 96 (2) ◽  
pp. E27-E31
Author(s):  
Patrick S. Carpenter ◽  
Ryan C. Burgette ◽  
John P. Leonetti ◽  
Sam J. Marzo
Keyword(s):  
Risk Factors ◽  
Skull Base ◽  
Temporal Bone ◽  
Blood Supply ◽  
Potential Risk ◽  
Infratemporal Fossa ◽  
Smoking History ◽  
Reconstructive Procedures ◽  
Lateral Skull Base ◽  
Potential Risk Factors

Neoplasms located in the parotid region, temporal bone, infra-temporal fossa, and lateral skull base represent a challenge due to their difficult anatomic location and surrounding neurovascular structures. A variety of surgical approaches are appropriate to access this area, although several of them can place the auricular blood supply in danger. If the auricular blood supply is compromised, ischemia and, eventually, avascular necrosis of the auricle can occur. Auricular necrosis often can cause patients a delay in adjuvant radiation therapy and result in the need for additional reconstructive procedures. There-fore, it is imperative to identify risk factors associated with the development of this disabling complication. We conducted a retrospective review of 32 individuals undergoing treatment of benign and malignant lesions in the parotid gland, infratemporal fossa, and lateral skull base. To identify potential risk factors for auricular necrosis, the patients were analyzed based on the type of neoplasm (malignant or benign), risk factors affecting blood flow (diabetes mellitus, smoking history, prior radiation, prior surgery), body mass index, and the length of surgery. In our population examined, 3 instances of auricular necrosis occurred. None of the potential risk factors proved to be statistically significant (although malignant pathology approached significance at p = 0.07). Two of the patients required an auriculectomy with reconstruction. The third had multiple postoperative clinic visits for surgical debridement. Although no potential risk factors were statistically significant, surgeons should remain cognizant of the auricular blood supply while performing surgery via preauricular and postauricular approaches to this area.

An Update on the Surgical Treatment of Temporal Bone Paraganglioma

2000 ◽  
Vol 13 (1_suppl) ◽  
pp. 179-188
Author(s):  
Kris S. Moe ◽  
Daqing Li ◽  
Thomas E. Linder ◽  
Stephan Schmid ◽  
Ugo Fisch
Keyword(s):  
Surgical Treatment ◽  
Temporal Bone ◽  
Surgical Resection ◽  
Infratemporal Fossa ◽  
Cranial Nerves ◽  
Disease Free Survival ◽  
Current Therapy ◽  
Intracranial Extension ◽  
Tumor Excision ◽  
Intradural Tumor

In 1982, Fisch described his results for the surgical treatment of 74 paragangliomas of the temporal bone, 5 years after his description of the infratemporal fossa approaches (types A and B). This study reviews the subsequent experience of the Department of Otolaryngology—Head and Neck Surgery of the University of Zürich with more than 136 surgically treated cases of paraganglioma of the temporal bone and discusses our current therapy 20 years after the initial description. One hundred nineteen (90%) of the patients had advanced tumors (Fisch class C or C+D), and 81 (68%) had intracranial extension. Total tumor excision was possible in 109 (82%) patients. Subtotal excision was performed in 22 (17%) patients, 21 of whom had intradural tumor invasion. In these cases, the resection was limited not by actual tumor size but by the degree of intracranial intradural tumor extension. Partial tumor excision was undertaken in only 1 patient with a C4De2Di2 tumor. The success rate in preservation of function of the lower cranial nerves was encouraging. Of the 69 patients whose facial nerve status was followed postoperatively, 81% maintained Fisch grade 76 to 100% (House-Brackman grades I and II). Analysis of follow-up data ranging from 2 to 11 years demonstrated 98% disease-free survival when total tumor extirpation was possible. In the patients who underwent subtotal or partial surgical resection there has been no subsequent tumor growth detected by either clinical or neuroradiological evaluation. We have confirmed after more than 20 years of experience that the infratemporal fossa approaches are a safe, highly effective means of surgical management of paragangliomas of the temporal bone, allowing eradication or arrest of disease with minimal morbidity. Limited intradural surgical resection in cases of very extensive tumors can greatly benefit patients for whom complete excision is not an option.

A common sense approach to radiation treatment planning of temporal lobe GBM

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 2044-2044
Author(s):  
F. Bokstein ◽  
F. Kovner ◽  
Z. Ram ◽  
H. Templehoff ◽  
A. A. Kanner ◽  
...  
Keyword(s):  
Temporal Bone ◽  
Temporal Lobe ◽  
Stable Disease ◽  
Radiation Treatment ◽  
Combined Modality Therapy ◽  
Infratemporal Fossa ◽  
Tumor Control ◽  
High Dose ◽  
Tumor Spread ◽  
Local Progression

2044 Background: Irradiation remains the cornerstone of management for glioblastoma multiforme (GBM). Guidelines adopted by the RTOG and EORTC advocate encompassing the primary tumor (sometimes with edema), and a 2 cm margin in the high dose volume. These recommendations have emerged from imaging studies and post-mortem analyses. A shortcoming of this approach is the exposure of critical structures (e.g. optic apparatus) to doses of radiation that may exceed organ tolerance. We sought to determine whether the temporal bone (rather than the aforementioned 2 cm radius) serves as a barrier to tumor spread when regarded as the anterior margin for temporal lobe lesions. We hypothesized that toxicity could be reduced without compromising tumor control. Methods: During the period 2003–2006, 250 patients with GBM were treated with surgery and primary irradiation at our institution. Chemotherapy (e.g., Stupp regimen) was given to approximately one-third of patients. 31 patients had lesions confined to the temporal lobe. All patients had MRI at baseline and at monthly intervals following a course of 60 Gy delivered by conformal techniques. The Clinical Target Volume included the primary lesion, the edema when present and a 2 cm margin except in the direction of the temporal bone. At follow-up (median = 10 months), patients were judged to have stable disease, local progression (i.e. failure within the temporal lobe), distant progression (i.e., brain failure beyond the temporal lobe) or combinations of the latter 2. Results: 11 patients have remained with stable disease. 17 have failed locally. 3 have manifested distant failure. Of the latter, only one patient failed in the infratemporal fossa. Conclusions: An acceptable level of recurrence (e.g., <5% beyond the temporal bone) is seen when the temporal bone, rather than a 2 cm margin is employed as the anterior border of the CTV. As GBM patients live longer in the era of combined modality therapy, a greater opportunity will exist to express radiation damage. The strategy proposed herein provides tumor control while respecting optic tolerance without resorting to complex, expensive approaches such as IMRT. No significant financial relationships to disclose.

Selection of surgical approaches for meningiomas affecting the temporal bone

1992 ◽  
Vol 107 (6_part_1) ◽  
pp. 738-744 ◽  
Author(s):  
Moises Arriaga ◽  
Clough Shelton ◽  
Paul Nassif ◽  
Derald E. Brackmann
Keyword(s):  
Facial Nerve ◽  
Temporal Bone ◽  
Surgical Approach ◽  
Infratemporal Fossa ◽  
Surgical Approaches ◽  
Recurrence Rates ◽  
Surgical Morbidity ◽  
Long Term Outcome ◽  
Selection Of

The varied locations of meningiomas within the temporal bone require a wide array of neurotologic approaches to accomplish complete resection with minimal morbidity. We reviewed 56 consecutive patients with temporal bone meningiomas. The six surgical approaches are described with regard to site of lesion, morbidity of procedure, and long-term patient outcome. Recommendations are made for selection of surgical approach. Hearing preservation was attempted in 25%. Middle fossa tumor removal was performed in nine patients (16%), retrosigmoid (suboccipital) in five patients (9%), translabyrinthine In 24 patients (43%), transcochlear in 15 patients (27%), infratemporal fossa In two patients (4%), and retrolabyrinthine In one patient (2%). Overall, meningioma surgery has higher morbidity, poorer facial nerve outcome, and higher recurrence rates than acoustic neuroma surgery. Thirteen percent of patients were unable to resume full preoperative activities after their surgery. Facial nerve transection occurred In 9% of the cases, and 83% of cases with more than 1 year followup had satisfactory or Intermediate facial function (grades I to IV). Meningiomas of the temporal bone are insidious and aggressive lesions. Particular care is required to select the surgical approach appropriate for location, level of hearing, and the anatomic structures Involved. Patients must be realistically counseled about the surgical morbidity and long-term outcome associated with each approach.

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