title: Temporal craniotomy for surgical access to the infratemporal fossa.
abstract: We propose a surgical approach for select patients that minimizes morbidity while allowing gross total resection of lesions in the anterior portion of the infratemporal fossa. The approach we describe is an extradural approach through a subtemporal craniectomy or craniotomy with the possible addition of a zygomatic osteotomy. Lesions that have a well-defined capsule and a texture that permits manipulation are ideal for this less invasive approach. We retrospectively reviewed six cases from the primary author (C.B.H.) using a temporal craniectomy or craniotomy alone to resect lesions in the infratemporal fossa. All six cases had good clinical outcomes with no unexpected neurological deficits while achieving gross total resections. The only complication included one cerebrospinal fluid leak that was sealed endoscopically. For select lesions, a less morbid surgical approach via an extradural window through a subtemporal craniectomy or small craniotomy may be preferable to transfacial approaches. Adjuvant use of endoscopic techniques may facilitate surgical exposure and resection of large lesions.
authors.affiliation: Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts.
authors.forename: Steven W
authors.initials: SW
authors.lastname: Hwang
authors.forename: Jason P
authors.initials: JP
authors.lastname: Rahal
authors.forename: Richard O
authors.initials: RO
authors.lastname: Wein
authors.forename: Carl B
authors.initials: CB
authors.lastname: Heilman
references.citation: J Neurosurg. 1987 Oct;67(4):488-99
references.pmid: 3655886
references.citation: Laryngoscope. 1983 Jan;93(1):36-44
references.pmid: 6185810
references.citation: Ear Nose Throat J. 1999 May;78(5):350, 353-6
references.pmid: 10355196
references.citation: Arch Otolaryngol. 1979 Feb;105(2):99-107
references.pmid: 760719
references.citation: Adv Otorhinolaryngol. 1984;34:242-53
references.pmid: 6516956
references.citation: Ear Nose Throat J. 2006 Nov;85(11):740-3, 746
references.pmid: 17168151
references.citation: J Laryngol Otol. 1978 Nov;92(11):949-67
references.pmid: 213516
references.citation: Neurosurgery. 1998 Oct;43(4):842-52; discussion 852-3
references.pmid: 9766312
references.citation: J Craniomaxillofac Surg. 1998 Apr;26(2):84-6
references.pmid: 9617670
references.citation: Neurosurgery. 1996 Oct;39(4):777-85; discussion 785-6
references.pmid: 8880773
references.citation: Acta Neurochir (Wien). 1996;138(3):255-64
references.pmid: 8861693
references.citation: Otolaryngol Head Neck Surg. 1999 Jan;120(1):17-24
references.pmid: 9914544
references.citation: Surg Neurol. 2002 Jul;58(1):21-31; discussion 31
references.pmid: 12361643
references.citation: Neurosurgery. 2005 Oct;57(4 Suppl):339-47; discussion 339-47
references.pmid: 16234683
references.citation: Keio J Med. 1999 Dec;48(4):189-200
references.pmid: 10638143
references.citation: Ann Otol Rhinol Laryngol. 1982 Sep-Oct;91(5 Pt 1):474-9
references.pmid: 6291440
references.citation: Adv Otorhinolaryngol. 1984;34:254-66
references.pmid: 6097104
references.citation: Surg Neurol. 2006;66 Suppl 1:S10-7; discussion S17
references.pmid: 16904988
references.citation: Acta Neurochir (Wien). 1995;136(1-2):99-102
references.pmid: 8748836
references.citation: Plast Reconstr Surg. 2005 Mar;115(3):711-20
references.pmid: 15731668