Transzygomatic approach with intraoperative neuromonitoring for resection of middle cranial fossa tumors.
The authors reviewed the surgical experience and operative technique in a series of 11 patients with middle fossa tumors who underwent surgery using the transzygomatic approach and intraoperative neuromonitoring (IOM) at a single institution. This approach was applied to trigeminal schwannomas (n = 3), cavernous angiomas (n = 3), sphenoid wing meningiomas (n = 3), a petroclival meningioma (n = 1), and a hemangiopericytoma (n = 1). An osteotomy of the zygoma, a low-positioned frontotemporal craniotomy, removal of the remaining squamous temporal bone, and extradural drilling of the sphenoid wing made a flat trajectory to the skull base. Total resection was achieved in 9 of 11 patients. Significant motor pathway damage can be avoided using a change in motor-evoked potentials as an early warning sign. Four patients experienced cranial nerve palsies postoperatively, even though free-running electromyography of cranial nerves showed normal responses during the surgical procedure. A simple transzygomatic approach provides a wide surgical corridor for accessing the cavernous sinus, petrous apex, and subtemporal regions. Knowledge of the middle fossa structures is essential for anatomic orientation and avoiding injuries to neurovascular structures, although a neuronavigation system and IOM helps orient neurosurgeons.
Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea.
Byung Chul
BC
Son
Sang Won
SW
Lee
Sup
S
Kim
Jae Taek
JT
Hong
Jae Hoon
JH
Sung
Seung-Ho
SH
Yang
intraoperative monitoring; middle fossa approach; motor-evoked potentials; neurophysiology; skull base surgery