1
|
Full Facial Allotransplantation Including the Temporomandibular Joints: A Radiologic and Anatomical Cadaveric Study. Plast Reconstr Surg 2020; 146:622-632. [PMID: 32459733 DOI: 10.1097/prs.0000000000007069] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Facial allotransplantation including the temporomandibular joints may improve the functional outcomes in face transplant candidates who have lost or damaged this joint. METHODS Linear and angular measurements were taken in 100 dry skulls and mandibles and in 100 three-dimensionally-reconstructed facial computed tomographic scans to determine the variability of the temporomandibular joint, glenoid fossa, and mandible. A vascular study was performed in six fresh cadaveric heads, followed by harvest of the face allograft in three heads. Next, four heads were used for mock transplantation (two donors and two recipients). The full facial allograft included four different segments: a Le Fort III, a mandibular tooth-bearing, and two condyle and temporomandibular joint-bearing segments. Statistical analysis was performed using SAS software. RESULTS In only one-third of the skulls, the condylar shape was symmetric between right and left sides. There was a wide variability in the condylar coronal (range, 14.3 to 23.62 mm) and sagittal dimensions (range, 5.64 to 10.96 mm), medial intercondylar distance (range, 66.55 to 89.91 mm), and intercondylar angles (range, 85.27 to 166.94 degrees). This high variability persisted after stratification by sex, ethnicity, and age. The temporomandibular joint was harvested based on the branches of the superficial temporal and maxillary arteries. The design of the allograft allowed fixation of the two condyle and temporomandibular joint-bearing segments to the recipient skull base, preserving the articular disk-condyle-fossa relationship, and differences were adjusted at the bilateral sagittal split osteotomy sites. CONCLUSION Procurement and transplantation of a temporomandibular joint-containing total face allograft is technically feasible in a cadaveric model.
Collapse
|
2
|
Discussion: Full Facial Allotransplantation Including the Temporomandibular Joints: A Radiologic and Anatomical Cadaveric Study. Plast Reconstr Surg 2020; 146:635-636. [PMID: 32842113 DOI: 10.1097/prs.0000000000007128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
3
|
Gagliardi F, Piloni M, Bailo M, Boari N, Calvanese F, Spina A, Caputy AJ, Mortini P. Comparative anatomical study on the role of zygomatic osteotomy in the extradural subtemporal approach to the clival region, when less is more. Surg Radiol Anat 2020; 42:567-575. [DOI: 10.1007/s00276-019-02407-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/18/2019] [Indexed: 02/07/2023]
|
4
|
|
5
|
Ferrari M, Schreiber A, Mattavelli D, Belotti F, Rampinelli V, Lancini D, Doglietto F, Fontanella MM, Tschabitscher M, Rodella LF, Nicolai P. The Inferolateral Transorbital Endoscopic Approach: A Preclinical Anatomic Study. World Neurosurg 2016; 90:403-413. [PMID: 26987633 DOI: 10.1016/j.wneu.2016.03.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/07/2016] [Accepted: 03/07/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND In recent years, transorbital endoscopic approaches are increasing in popularity as they provide several corridors to reach lateral areas of the ventral skull base through the orbit. The aim of this study is to investigate the feasibility of the inferolateral transorbital endoscopic approach (ILTEA) by detailing the step-by-step dissection, anatomic landmarks, and target anatomic areas. METHODS Seven cadaveric specimens (14 sides) were dissected in the Laboratory of Endoscopic Anatomy of the University of Brescia. Step-by-step dissection of ILTEA was performed to identify the main anatomic landmarks and corridors. Skin incision, dural incision, and boundaries of craniectomy were measured. Neuronavigation was used to check landmarks, track boundaries of surgical volumes, and measure orbital dislocation. RESULTS The study on the 14 ILTEAs defined 1 anatomic area ("waterline door") that leads to 4 corridors: Meckel's cave corridor, carotid foramen corridor, petrous corridor, and transdural middle fossa corridor. Crucial anatomic landmarks were identified and analyzed. Orbital dislocation was <10 mm. CONCLUSIONS ILTEA provides the surgeon with a direct route to the region of the "waterline door," lateral areas of the ventral skull base, and middle cranial fossa. In addition, it allows an optimal view of the intracranial and extracranial portions of the maxillary and mandibular nerves. Further anatomic and clinical studies are needed to validate ILTEA in surgical practice.
Collapse
Affiliation(s)
- Marco Ferrari
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
| | - Alberto Schreiber
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Francesco Belotti
- Unit of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Davide Lancini
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Francesco Doglietto
- Unit of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Maria Fontanella
- Unit of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Manfred Tschabitscher
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Luigi Fabrizio Rodella
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Piero Nicolai
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| |
Collapse
|
6
|
Middle infratemporal fossa less invasive approach for radical resection of parapharyngeal tumors: surgical microanatomy and clinical application. Neurosurg Rev 2015; 39:87-96; discussion 96-7. [PMID: 26160680 DOI: 10.1007/s10143-015-0655-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 01/22/2015] [Accepted: 04/25/2015] [Indexed: 10/23/2022]
Abstract
Surgery of the infratemporal fossa (ITF) and parapharyngeal area presents a formidable challenge to the surgeon due to its anatomical complexity and limited access. Conventional surgical approaches to these regions were often too invasive and necessitate sacrifice of normal function and anatomy. To describe a less invasive transcranial extradural approach to ITF parapharyngeal lesions and to determine its advantages, 17 patients with ITF parapharyngeal neoplasms who underwent tumor resection via this approach were enrolled in the study. All lesions located in the ITF precarotid parapharyngeal space were resected through a small operative corridor between the trigeminal nerve third branch (V3) and the temporomandibular joint (TMJ). Surgical outcomes and postoperative complications were evaluated. Pathological diagnosis included schwannoma in eight cases, paraganglioma in two cases, gangliocytoma in two cases, carcinosarcoma in one case, giant cell tumor in one case, pleomorphic adenoma in one case, chondroblastoma in one case, and juvenile angiofibroma in one case. Gross total resection was achieved in 12 cases, near-total and subtotal resection were in 3 and 2 cases, respectively. The most common postoperative complication was dysphagia. Surgical exposure can be customized from minimal (drilling of retrotrigeminal area) to maximal (full skeletonization of V3, removal of all structures lying lateral to the petrous segment of internal carotid artery) according to tumor size and location. Since the space between the V3 and TMJ is the main corridor of this approach, the key maneuver is the anterior translocation of V3 to obtain an acceptable surgical field.
Collapse
|
7
|
Comparison of lateral microsurgical preauricular and anterior endoscopic approaches to the jugular foramen. The Journal of Laryngology & Otology 2015; 129 Suppl 2:S12-20. [DOI: 10.1017/s0022215114002321] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractIntroduction:This project compares access to the anterolateral part of the jugular foramen provided by the lateral microsurgical preauricular and the anterior endoscopic approaches, and defines the important landmarks involved in each approach.Study Design:Cadaveric study.Results:The endoscopic transnasal/transmaxillary transpterygoid corridor provides a less invasive route for selected lesions in the jugular foramen than the traditional open route through the preauricular subtemporal infratemporal fossa approach. However, the anterior endoscopic approach provides a smaller channel to the jugular foramen than the preauricular approach.Conclusions:The anterior endoscopic approach to the anterolateral part of the jugular foramen is a useful alternative to the lateral microsurgical preauricular approach in carefully selected cases. The vaginal process of the tympanic part of the temporal bone provides a valuable landmark to aid in accessing the jugular foramen in both procedures and can be drilled to open the foramen in the preauricular approach.
Collapse
|
8
|
Komune N, Komune S, Morishita T, Rhoton AL. Microsurgical anatomy of subtotal temporal bone resection en bloc with the parotid gland and temporomandibular joint. Neurosurgery 2015; 10 Suppl 2:334-56; discussion 356. [PMID: 24561868 DOI: 10.1227/neu.0000000000000324] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Subtotal temporal bone resection (STBR) has been used for half a century to remove temporal bone malignancies. However, there are few reports on the detailed anatomy involved in the resection. OBJECTIVE To describe the microsurgical anatomy of STBR combined en bloc with the resection of the parotid gland and temporomandibular joint (TMJ). METHODS Cadaveric specimens were dissected in a stepwise manner using 3× to 40× magnification. RESULTS STBR can be combined with the total parotidectomy and the resection of the TMJ if the tumor extends into the parotid gland, TMJ, or facial nerve. In this study, we describe the step-by-step microsurgical anatomy of STBR en bloc with the parotid gland and TMJ. The surgical technique described combines 3 approaches: the high cervical, subtemporal-infratemporal fossa, and retromastoid-paracondylar approaches. Combining these 3 approaches aided in efficiently completing this modified approach. CONCLUSION STBR is a complicated and technically challenging procedure. This study highlights the importance of understanding the surgical anatomy of STBR and will serve as a catalyst for improvement of the surgical technique for temporal bone resection.
Collapse
Affiliation(s)
- Noritaka Komune
- *Department of Neurosurgery, University of Florida, College of Medicine, Gainesville, Florida; ‡Department of Otorhinolaryngology Head and Neck Surgery, Kyushu University, Fukuoka, Japan
| | | | | | | |
Collapse
|
9
|
Youssef A, Carrau RL, Tantawy A, Ibrahim AA, Prevedello DM, Otto BA, Solares AC, Ditzel Filho LFS, Rompaey J. Clinical correlates of the anatomical relationships of the foramen ovale: a radioanatomical study. J Neurol Surg B Skull Base 2014; 75:427-34. [PMID: 25452902 DOI: 10.1055/s-0034-1386654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 05/27/2014] [Indexed: 10/24/2022] Open
Abstract
Introduction Endonasal endoscopic transpterygoid approaches are commonly used techniques to access the infratemporal fossa and parapharyngeal space. Important endoscopic endonasal landmarks for the poststyloid parapharyngeal space, hence the internal carotid artery, include the mandibular nerve at the level of foramen ovale and the lateral pterygoid plate. This study aims to define the anatomical relationships of the foramen ovale, establishing its distance to other important anatomical landmarks such as the pterygoid process and columella. Methods Distances between the foramen ovale, foramen rotundum, and fixed anatomical landmarks like the columella and pterygoid process were measured using computed tomography (CT) scans and cadaveric dissections of the pterygopalatine and infratemporal fossae. Results The mean distances from the foramen ovale to columella and from the foramen rotundum to columella were found to be 9.15 cm and 7.09 cm, respectively. Analysis of radiologic measurements detected no statistically significant differences between sides or gender. Conclusions The pterygoid plates and V3 are prominent landmarks of the endonasal endoscopic approach to the infratemporal fossa and poststyloid parapharyngeal space. A better understanding of the endoscopic anatomy of the infratemporal fossa and awareness of the approximate distances and geometry among anatomical landmarks facilitates a safe and complete resection of lesions arising or extending to these regions.
Collapse
Affiliation(s)
- Ahmed Youssef
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University, Columbus, Ohio, United States ; Department of Otolaryngology-Head and Neck Surgery, Alexandria University, El Azareeta, Alexandria, Egypt
| | - Ricardo L Carrau
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University, Columbus, Ohio, United States
| | - Ahmed Tantawy
- Department of Otolaryngology-Head and Neck Surgery, Alexandria University, El Azareeta, Alexandria, Egypt
| | - Ahmed Ali Ibrahim
- Department of Otolaryngology-Head and Neck Surgery, Alexandria University, El Azareeta, Alexandria, Egypt
| | - Daniel M Prevedello
- Department of Neurosurgery, The University of Ohio, Columbus, Ohio, United States
| | - Bradley A Otto
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University, Columbus, Ohio, United States
| | - Arturo C Solares
- Department of Otolaryngology-Head and Neck Surgery, Georgia Regents Medical Center, Augusta, Georgia, United States
| | - Leo F S Ditzel Filho
- Department of Neurosurgery, The University of Ohio, Columbus, Ohio, United States
| | - Jason Rompaey
- Department of Otolaryngology-Head and Neck Surgery, Georgia Regents Medical Center, Augusta, Georgia, United States
| |
Collapse
|
10
|
Endonasal, transmaxillary, transpterygoid approach to the foramen ovale: radio-anatomical study of surgical feasibility. The Journal of Laryngology & Otology 2013; 127:1093-102. [DOI: 10.1017/s0022215113002338] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:This study aimed to examine the feasibility of an endonasal, transmaxillary, transpterygoid approach to the foramen ovale by examining key anatomical, radiological and surgical landmarks.Method:Measurements were taken from 183 patients' computed tomography scans using BrainLAB iPlan 1.1 Cranial software. Endoscopic dissection was then carried out on a cadaver to assess surgical viability.Results:We found that the distances from the posterior maxillary wall to the foramen ovale and from the anterior nasal spine to the foramen ovale were statistically significantly larger in men than women. The distance from the base of the lateral pterygoid plate to the foramen ovale, and the angle between the foramen ovale, the anterior nasal spine and the sphenoid rostrum, were constant between the sexes. The importance of the lateral pterygoid plate in locating the foramen ovale was demonstrated.Conclusion:With the increasing popularity of image guidance and assisted navigation in endoscopic surgery, these findings increase anatomico-radiological understanding of the surgical approach investigated.
Collapse
|
11
|
Komatsu F, Komatsu M, Di Ieva A, Tschabitscher M. Endoscopic extradural subtemporal approach to lateral and central skull base: a cadaveric study. World Neurosurg 2012; 80:591-7. [PMID: 23247026 DOI: 10.1016/j.wneu.2012.12.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Revised: 04/21/2012] [Accepted: 12/11/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Endoscopy has provided a less invasive approach to skull base surgery, mainly through endonasal routes, but has been limited in its applications due to potential complications. The aims of this study were to evaluate the feasibility of the purely endoscopic extradural transcranial approach to lateral and central skull base through a subtemporal keyhole and to better understand potential distortions of the related anatomy via endoscopy. METHODS Ten fresh cadaver heads were studied with 4-mm 0° and 30° endoscopes to develop the surgical approach and to identify surgical landmarks. RESULTS The endoscopic extradural subtemporal approach was divided into 3 sections after exposure of the extradural space in the middle cranial fossa: 1) exposure of the lateral wall of the cavernous sinus and the preauricular infratemporal fossa; 2) anterior petrosectomy and posterior cranial fossa exploration; and 3) unroofing of the tympanic cavity and exposure of the facial nerve. This keyhole endoscopic technique clearly visualized anatomical landmarks of the lateral and central skull base via an extradural subtemporal route. CONCLUSIONS The endoscopic extradural subtemporal approach was feasible. This approach could display a wide range of lateral and central skull base structures with minimal invasiveness. The use of extradural space would be key to performing safe and effective endoscopic skull base surgery.
Collapse
Affiliation(s)
- Fuminari Komatsu
- Center for Anatomy and Cell Biology, Department of Systematic Anatomy, Medical University of Vienna, Vienna, Austria.
| | | | | | | |
Collapse
|
12
|
Wanibuchi M, Murakami G, Yamashita T, Minamida Y, Fukushima T, Friedman AH, Fujimiya M, Houkin K. Midsubtemporal ridge as a predictor of the lateral loop formed by the maxillary nerve and mandibular nerve: a cadaveric morphological study. Neurosurgery 2011; 69:ons95-8; discussion ons98. [PMID: 21346652 DOI: 10.1227/neu.0b013e31821247f5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The lateral loop formed by the maxillary nerve (V2) and the mandibular nerve (V3) consists of a part of the far lateral triangle of the cavernous sinus. Because this triangle becomes a surgical corridor of the preauricular infratemporal fossa approach and a landmark of the extradural approach for the ganglion-type trigeminal schwannomas, identification of the lateral loop has important implications at the early stage of middle cranial base surgery. We realized that a bony ridge usually existed just lateral to the lateral loop. OBJECTIVE To nominate midsubtemporal ridge (MSR) as the name for this anatomically unnamed bony ridge and to clarify its features. METHODS Using 35 cadaver heads, we measured the shape of the MSR on both sides and the distance between the MSR and the adjacent structures. RESULTS The MSR was recognized in 60 of 70 specimens (85.7%). The bony protrusion was 2.9 ± 1.1 mm in height, 6.0 ± 2.1 mm in width, and 9.1 ± 3.2 mm in length. A single peak with anteroposterior length was common in 47 of 60 specimens (78.3%). The MSR was located at the midpoint of the V2 and V3 in 28 specimens (46.7%) and existed 10.7 ± 3.6 mm lateral from the line that bound the foramen rotundum and the foramen ovale. CONCLUSION We demonstrate morphological characteristics of the MSR. These data on the MSR will assist the surgeon in identifying the lateral loop as a surgical landmark during middle cranial base surgery.
Collapse
Affiliation(s)
- Masahiko Wanibuchi
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Meng Q, Li B, Long X, Li J, Yan Q. Ankylosis of temporomandibular joint after the traumatic brain injury: a report of two cases. Dent Traumatol 2011; 29:328-33. [PMID: 22008514 DOI: 10.1111/j.1600-9657.2011.01068.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Mouth opening limitation after the neurosurgical procedures is a common complication and usually resolves within 3 months. If limited mouth opening remains unresolved on the long term, an intra-articular ankylosis of temporomandibular joint may develop eventually. The possible mechanisms base on the myositis and atrophy of the masticatory muscles for these craniotomies are often involved in the temporalis. This article reports two unusual cases with the intra-articular ankylosis of temporomandibular joint after the traumatic brain injury, who received a modified surgical treatment for joint ankylosis. Therefore, the early diagnosis and intervention are important to minimize these complications.
Collapse
Affiliation(s)
- Qinggong Meng
- Department of Oral and Maxillofacial Surgery, The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China
| | | | | | | | | |
Collapse
|
14
|
Conservative Treatment of Severe Limited Mouth Opening After Transtemporal Craniotomy. J Craniofac Surg 2011; 22:1746-50. [DOI: 10.1097/scs.0b013e31822e62bf] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
15
|
Wanibuchi M, Fukushima T, Zomordi AR, Nonaka Y, Friedman AH. Trigeminal Schwannomas: Skull Base Approaches and Operative Results in 105 Patients. Oper Neurosurg (Hagerstown) 2011; 70:132-43; discussion 143-4. [DOI: 10.1227/neu.0b013e31822efb21] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Trigeminal schwannomas make up 0.8% to 8% of all intracranial schwannomas.
OBJECTIVE:
To analyze our surgical experience with trigeminal schwannomas.
METHODS:
We performed 107 operations on 105 patients harboring trigeminal schwannomas over the past 30 years. We classified the tumors as peripheral, ganglion cavernous, posterior fossa root, and dumbbell types according to the portion of the nerve that gave rise to the tumor.
RESULTS:
Fourteen were peripheral-type tumors (13.1%), 39 (36.4%) were ganglion cavernous type, 22 (20.6%) were posterior fossa root type, and 32 (30.0%) were dumbbell type. Sixty-five tumors were solid, 35 were mixed, and only 7 were cystic. Among solid tumors, 14 were vascular, fibrous, and adherent to adjacent structures. Total or near-total removal was performed in 86 cases (81.9%), and subtotal removal was achieved in 18 (17.1%). The most common symptom was facial hypesthesia, occurring in 69 patients. This symptom improved in 11 patients, persisted in 50 patients, and worsened in 8 patients after surgery. New postoperative hypesthesia was observed in 8 patients. The second most common symptom was facial pain, observed in 24 patients. Facial pain subsided in 22 and persisted in 2 patients after surgery. Diplopia was observed in 21 patients. This symptom improved postoperatively in 14 patients, persisted in 6 patients, and worsened in 1 patient.
CONCLUSION:
The present series demonstrates acceptable results using microsurgical treatment to remove trigeminal schwannomas. Pain and diplopia may be relieved after surgery; however, hypesthesia frequently remains or may be worsened by surgery.
Collapse
Affiliation(s)
- Masahiko Wanibuchi
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Hokkaido, Japan
- Carolina Neuroscience Institute for Skull Base Surgery, Raleigh, North Carolina
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Takanori Fukushima
- Carolina Neuroscience Institute for Skull Base Surgery, Raleigh, North Carolina
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Ali R. Zomordi
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Yoichi Nonaka
- Carolina Neuroscience Institute for Skull Base Surgery, Raleigh, North Carolina
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Allan H. Friedman
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
16
|
Mousa Sadr Hosseini S, Razfar A, Carrau RL, Prevedello DM, Fernandez-Miranda J, Zanation A, Kassam AB. Endonasal transpterygoid approach to the infratemporal fossa: Correlation of endoscopic and multiplanar CT anatomy. Head Neck 2011; 34:313-20. [DOI: 10.1002/hed.21725] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2010] [Indexed: 11/06/2022] Open
|
17
|
[Extended subtemporal approach to the subtemporal fossa and related structures - analysis of the surgical technique based on cadaver simulation]. Neurol Neurochir Pol 2010; 44:159-71. [PMID: 20496286 DOI: 10.1016/s0028-3843(14)60007-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The aim of the study was to present consecutive stages of the extended subtemporal approach (ESA). Seven simulations of ESA were performed on non-fixed human cadavers without any known pathologies in the head and neck. The consecutive stages of the procedure were documented with photographs and schemes. The starting point for ESA is osteotomy of the zygomatic arch and craniectomy including the greater wing of the sphenoid bone. Dislocation or removal of subtemporal fossa contents allows one to penetrate its inside and related structures. Additional widening of inspection allows osteotomy of the condyloid process of the mandible. ESA is a reproducible technique which provides surgical penetration of the subtemporal fossa and related structures. This approach is particularly useful in the surgical treatment of tumours expanding in the orbit, maxillary sinus, pterygopalatine fossa, nasopharynx, sphenoid sinus, cavernous sinus, parapharyngeal space, retromandibular fossa and surroundings of the petrosal part of the internal carotid artery.
Collapse
|
18
|
Leiggener C, Jaquiéry C, Kunz C, Westermark A. Transparotid approach for tumor excision from the infratemporal space in temporomandibular joint reconstruction: a 3-year follow-up. ACTA ACUST UNITED AC 2010; 109:e1-4. [DOI: 10.1016/j.tripleo.2009.08.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Revised: 08/01/2009] [Accepted: 08/11/2009] [Indexed: 10/20/2022]
|
19
|
YOSHIDA K, KAWASE T, TOMITA T, OGAWA K, KAWANA H, YAGO K, ASANAMI S. Surgical Strategy for Tumors Located in or Extending From the Intracranial Space to the Infratemporal Fossa -Advantages of the Transcranial Approach (Zygomatic Infratemporal Fossa Approach) and the Indications for a Combined Transcranial and Transcervical Approach-. Neurol Med Chir (Tokyo) 2009; 49:580-6. [DOI: 10.2176/nmc.49.580] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Takeshi KAWASE
- Department of Neurosurgery, Keio University School of Medicine
| | - Toshiki TOMITA
- Department of Otolaryngology, Keio University School of Medicine
| | - Kaoru OGAWA
- Department of Otolaryngology, Keio University School of Medicine
| | - Hiromasa KAWANA
- Department of Dentistry and Oral Surgery, Keio University School of Medicine
| | - Kaori YAGO
- Department of Dentistry and Oral Surgery, Keio University School of Medicine
| | - Soichiro ASANAMI
- Department of Dentistry and Oral Surgery, Keio University School of Medicine
| |
Collapse
|
20
|
Froelich S, Aziz KA, Levine NB, Tew JM, Keller JT, Theodosopoulos PV. Extension of the one-piece orbitozygomatic frontotemporal approach to the glenoid fossa: cadaveric study. Neurosurgery 2008; 62:ONS312-6; discussion ONS316-7. [PMID: 18596509 DOI: 10.1227/01.neu.0000326012.91939.fb] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Resection of the glenoid fossa has been described as part of cranial approaches to the clivus and subtemporal approaches. However, radical resection carries a significant risk of postoperative temporomandibular joint dysfunction. We examine a simple variation of our previously described one-piece frontotemporal orbitozygomatic (FTOZ) osteotomy that adds en bloc resection of the root of the zygomatic arch and a portion of the glenoid fossa. METHODS Five cadaveric fixed heads injected with colored silicone underwent an FTOZ osteotomy that extended to the root of the zygomatic arch and glenoid fossa. RESULTS A step-by-step guide to the surgical technique is described, with illustrations to depict the glenoid fossa keyhole and bony cuts that free the zygomatic arch and portions of glenoid fossa. The first cut was made through the posterior root, and the second cut was made through the anterior root of the zygomatic arch. CONCLUSION In this cadaveric study, extension of the one-piece FTOZ approach included the posterior root of the zygoma and the lateral part of the glenoid fossa. En bloc resection of the glenoid fossa and root of the zygomatic arch, together with the FTOZ osteotomy, facilitated reconstruction of the temporomandibular joint and increased the amount of exposure obtained with this FTOZ osteotomy. Comprehensive understanding of functional outcomes awaits further clinical study.
Collapse
Affiliation(s)
- Sebastien Froelich
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | | | | | | | | |
Collapse
|
21
|
Isaacson B, Kutz JW, Roland PS. Lesions of the petrous apex: diagnosis and management. Otolaryngol Clin North Am 2007; 40:479-519, viii. [PMID: 17544693 DOI: 10.1016/j.otc.2007.03.003] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Management of petrous apex pathology poses a unique challenge even to the most seasoned skull base surgeons. The central location in the skull base with adjacent critical neurovascular structures makes access to this region more than a trivial matter. Significant advances in diagnostic imaging have greatly facilitated the diagnosis of petrous apex lesions. The introduction of modern skull base surgery techniques also has provided skull base surgeons with numerous avenues to the petrous apex while significantly decreasing morbidity. The latest diagnostic and management strategies are discussed and an update of some of the more common pathologic entities is provided.
Collapse
Affiliation(s)
- Brandon Isaacson
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas-Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9035, USA.
| | | | | |
Collapse
|