Trans-zygomatic middle cranial fossa approach to access lesions around the cavernous sinus and anterior parahippocampus

A minimally invasive skull base approach

Itay Melamed, R. Shane Tubbs, Troy D. Payner, Aaron Cohen-Gadol

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Purpose: Exposure of the cavernous sinus or anterior parahippocampus often involves a wide exposure of the temporal lobe and mobilization of the temporalis muscle associated with temporal lobe retraction. The authors present a cadaveric study to illustrate the feasibility, advantages and landmarks necessary to perform a transzygomatic middle fossa approach to lesions around the cavernous sinus and anterior parahippocampus. Methods: The authors performed bilateral trans-zygomatic middle fossae exposures to reach the cavernous sinus and parahippocampus in five cadavers (10 sides). We assessed the morbidity associated with this procedure and compared the indications, advantages, and disadvantages of this method versus more extensive skull base approaches. A vertical linear incision along the middle portion of the zygomatic arch was extended one finger breadth inferior to the inferior edge of the zygomatic arch. Careful dissection inferior to the arch allowed preservation of facial nerve branches. A zygomatic osteotomy was followed via a linear incision through the temporalis muscle and exposure of the middle cranial fossa floor. Results: A craniotomy along the inferolateral temporal bone and middle fossa floor allowed extradural dissection along the middle fossa floor and exposure of the cavernous sinus including all three divisions of the trigeminal nerve. Intradural inspection demonstrated adequate exposure of the parahippocampus. Exposure of the latter required minimal or no retraction of the temporal lobe. Conclusions: The trans-zygomatic middle fossa approach is a simplified skull base exposure using a linear incision, which may avoid the invasivity of more extensive skull base approaches while providing an adequate corridor for resection of cavernous sinus and parahippocampus lesions. The advantages of this approach include its efficiency, ease, minimalism, preservation of the temporalis muscle, and minimal retraction of the temporal lobe.

Original languageEnglish
Pages (from-to)977-982
Number of pages6
JournalActa Neurochirurgica
Volume151
Issue number8
DOIs
StatePublished - Aug 2009

Fingerprint

Middle Cranial Fossa
Cavernous Sinus
Skull Base
Temporal Lobe
Zygoma
Muscles
Dissection
Trigeminal Nerve
Temporal Bone
Craniotomy
Facial Nerve
Osteotomy
Cadaver
Fingers
Morbidity

Keywords

  • Anatomy
  • Cavernous sinus
  • Parahippocampus
  • Trans-zygomatic approach

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Trans-zygomatic middle cranial fossa approach to access lesions around the cavernous sinus and anterior parahippocampus : A minimally invasive skull base approach. / Melamed, Itay; Tubbs, R. Shane; Payner, Troy D.; Cohen-Gadol, Aaron.

In: Acta Neurochirurgica, Vol. 151, No. 8, 08.2009, p. 977-982.

Research output: Contribution to journalArticle

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abstract = "Purpose: Exposure of the cavernous sinus or anterior parahippocampus often involves a wide exposure of the temporal lobe and mobilization of the temporalis muscle associated with temporal lobe retraction. The authors present a cadaveric study to illustrate the feasibility, advantages and landmarks necessary to perform a transzygomatic middle fossa approach to lesions around the cavernous sinus and anterior parahippocampus. Methods: The authors performed bilateral trans-zygomatic middle fossae exposures to reach the cavernous sinus and parahippocampus in five cadavers (10 sides). We assessed the morbidity associated with this procedure and compared the indications, advantages, and disadvantages of this method versus more extensive skull base approaches. A vertical linear incision along the middle portion of the zygomatic arch was extended one finger breadth inferior to the inferior edge of the zygomatic arch. Careful dissection inferior to the arch allowed preservation of facial nerve branches. A zygomatic osteotomy was followed via a linear incision through the temporalis muscle and exposure of the middle cranial fossa floor. Results: A craniotomy along the inferolateral temporal bone and middle fossa floor allowed extradural dissection along the middle fossa floor and exposure of the cavernous sinus including all three divisions of the trigeminal nerve. Intradural inspection demonstrated adequate exposure of the parahippocampus. Exposure of the latter required minimal or no retraction of the temporal lobe. Conclusions: The trans-zygomatic middle fossa approach is a simplified skull base exposure using a linear incision, which may avoid the invasivity of more extensive skull base approaches while providing an adequate corridor for resection of cavernous sinus and parahippocampus lesions. The advantages of this approach include its efficiency, ease, minimalism, preservation of the temporalis muscle, and minimal retraction of the temporal lobe.",
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