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DOI: 10.1055/s-0036-1592483
Infratemporal Approaches in the Management of Complex Pathologies of the Posterolateral Skull Base
Introduction: Infratemporal approaches (IFT) represent transtemporal approaches designed for management of pathological processes affecting posterolateral skull base.
Aim: To evaluate the indications and techniques of individual IFT.
Methods: Retrospective analysis and personal experience with employment of IFT in the period 1/2008 to 12/2015.
Results: Malignant tumors were treated in 13 cases (carcinomas: 6, sarcomas: 4, metastatic pleomorphic adenoma: 1, melanoma: 1, chondroblastoma: 1) and benign in 13 cases (paragangliomas/Fisch C1–3 Di1–2: 9, CN V schwannoma: 2, teratoma: 1, synovial chondromatosis: 1). IFT A (11) with the transposition of CN VII was used for pathologies affecting infralabyrinthine petrous bone, petrous apex, jugular bulb and horizontal ICA with eventual intradural extension. All patients suffered transient CN VII dysfunction (HB2–6) which improved in period of months (HB1–3). The incidence of dysfunction of CN IX-XI was determined by the type of pathology. IFT B (6) with mobilization of petrous ICA was employed for pathologies extending medially to horizontal and vertical portion of petrous ICA and the midportion of clivus. In 1 patient we experienced enormous intraoperative blood losses with subsequent hypoxic injury that was in direct relation to the death in the postoperative period. Other serious complications did not occur. IFT C (2) we used for pathologies spreading peritubal, to the infratemporal fossa, nasopharynx and parasellar location. IFT D (7) we performed to manage processes affecting the middle skull base with extra-and intracranial spread.
Conclusion: IFT enable management of complex pathologies affecting area of posterolateral skull base. To minimize complications optimum is the multidisciplinary approach.