J Neurol Surg B Skull Base 2016; 77 - FP-09-06
DOI: 10.1055/s-0036-1592483

Infratemporal Approaches in the Management of Complex Pathologies of the Posterolateral Skull Base

Martin Chovanec 1, 2, Eduard Zverina 2, Jan Betka 2, Jan Plzak 2, Ales Vlasak 3, Jiri Lisy 4, David Netuka 5, Frantisek Charvat 6
  • 1Department of Otorhinolaryngology, 3rd Faculty of Medicine, University Hospital Kralovske Vinohrady
  • 2Department of Otorhinolaryngology, Head and Neck Surgery, 1st Faculty of Medicine, University Hospital Motol
  • 3Department of Neurosurgery, 2nd Faculty of Medicine, University Hospital Motol
  • 4Department of Radiodiagnostics, 2nd Faculty of Medicine, University Hospital Motol
  • 5Department of Neurosurgery, 1st Faculty of Medicine, University Hospital Stresovice
  • 6Department of Radiology, University Hospital Stresovice Charles University Prague

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.