title: Endoscopic endonasal approaches to infratemporal fossa tumors: a classification system and case series.
abstract: OBJECTIVE
  To propose a clinically applicable anatomic classification system describing three progressive endoscopic endonasal approaches (EEAs) to the infratemporal fossa (ITF) and their potential sequelae. Overall feasibility and outcomes of these approaches are presented through a consecutive case series.
  
  
  METHODS
  Description of classification system for EEAs to the ITF and case series.
  
  
  METHODS
  A classification system of EEAs to ITF tumors was created based on the senior author's clinical experience and cadaveric dissection. A retrospective chart review of 21 child and adult patients with primary ITF tumors treated by these approaches from 2008 to 2012 at a tertiary-care academic medical center was conducted.
  
  
  RESULTS
  Three progressive EEAs to ITF tumors were defined: 1) a transpterygopalatine fossa approach, 2) a transmedial pterygoid plate approach, and 3) a translateral pterygoid plate approach. Twenty-one patients treated with these approaches were identified consecutively, with a mean age of 44.2 years (range, 11-79 years). Tumors primarily involving the pterygopalatine fossa and not the ITF were excluded. Pathology included three advanced juvenile nasopharyngeal angiofibromas, three adenoid cystic carcinomas, two recurrent inverted papillomas, two trigeminal schwannomas, and 11 other diverse skull base pathologies. No intraoperative or postoperative complications occurred, with a mean follow-up of 21.5 months (range, 1-55 months). Expected potential sequelae such as V2/palatal numbness, Eustachian tube dysfunction, and trismus occurred in 10/21 patients.
  
  
  CONCLUSIONS
  EEAs to ITF tumors are technically feasible with low risk of complications for well-selected patients. The proposed classification system is useful for anticipating potential sequelae for each approach.
authors.affiliation: Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Taylor
authors.forename: Mihir R
authors.initials: MR
authors.lastname: Patel
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Wheless
authors.forename: Kibwei A
authors.initials: KA
authors.lastname: McKinney
authors.forename: Michael E
authors.initials: ME
authors.lastname: Stadler
authors.forename: Deanna
authors.initials: D
authors.lastname: Sasaki-Adams
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Ewend
authors.forename: Anand V
authors.initials: AV
authors.lastname: Germanwala
authors.forename: Adam M
authors.initials: AM
authors.lastname: Zanation
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018322:Angiofibroma / Q000473:pathology / Q000601:surgery; D002648:Child; D015331:Cohort Studies; D035262:Cranial Fossa, Anterior / Q000601:surgery; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015192:Infratentorial Neoplasms / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000601:surgery; D009442:Neurilemmoma / Q000473:pathology / Q000601:surgery; D056739:Pterygopalatine Fossa / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D019292:Skull Base Neoplasms / Q000473:pathology* / Q000601:surgery*; D013702:Temporal Lobe / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult