Anatomic Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Infratemporal Fossa Approach to the Jugular Foramen.
Journal
Operative neurosurgery (Hagerstown, Md.)
ISSN: 2332-4260
Titre abrégé: Oper Neurosurg (Hagerstown)
Pays: United States
ID NLM: 101635417
Informations de publication
Date de publication:
01 Apr 2024
01 Apr 2024
Historique:
received:
15
08
2023
accepted:
14
09
2023
medline:
18
3
2024
pubmed:
17
11
2023
entrez:
17
11
2023
Statut:
ppublish
Résumé
The infratemporal fossa (ITF) is a complex region bounded by the temporal bone, maxilla, sphenoid, pterygoid plates, and mandibular ramus. Containing a high density of neurovascular and musculoskeletal structures, the ITF can house a number of pathologies, and access is challenging. The ITF approach and its variations can be challenging due to complex anatomy and unfamiliarity by many surgeons. The objective of this study was to present a step-by-step 3-dimensional anatomic dissection for the classic Fisch Type A and modified ITF approach from the surgeon's perspective. Six sides of 3 formalin-fixed latex-injected specimens were dissected under microscopic magnification (JRD and AMN). Standard Fisch Type A and modified ITF approaches were performed on contralateral sides of each specimen. Representative high-quality 3-dimensional photography was performed for each key step. The ITF approach affords excellent access to the posterior ITF and jugular foramen. Modifications to this approach include preservation of the ear canal and limiting facial nerve transposition, thus limiting morbidity while generally still providing sufficient access to key anatomic structures. The ITF approach provides access to the lateral skull base for jugular foramen paraganglioma and other lesions. Modifications of the classic Fisch Type A technique can be used to access pathologies in this region without sacrificing conductive hearing or facial nerve function. Three dimensional operatively oriented neuroanatomy dissections provide surgeons with a valuable resource for learning this complex surgical approach.
Sections du résumé
BACKGROUND AND OBJECTIVES
OBJECTIVE
The infratemporal fossa (ITF) is a complex region bounded by the temporal bone, maxilla, sphenoid, pterygoid plates, and mandibular ramus. Containing a high density of neurovascular and musculoskeletal structures, the ITF can house a number of pathologies, and access is challenging. The ITF approach and its variations can be challenging due to complex anatomy and unfamiliarity by many surgeons. The objective of this study was to present a step-by-step 3-dimensional anatomic dissection for the classic Fisch Type A and modified ITF approach from the surgeon's perspective.
METHODS
METHODS
Six sides of 3 formalin-fixed latex-injected specimens were dissected under microscopic magnification (JRD and AMN). Standard Fisch Type A and modified ITF approaches were performed on contralateral sides of each specimen. Representative high-quality 3-dimensional photography was performed for each key step.
RESULTS
RESULTS
The ITF approach affords excellent access to the posterior ITF and jugular foramen. Modifications to this approach include preservation of the ear canal and limiting facial nerve transposition, thus limiting morbidity while generally still providing sufficient access to key anatomic structures.
CONCLUSION
CONCLUSIONS
The ITF approach provides access to the lateral skull base for jugular foramen paraganglioma and other lesions. Modifications of the classic Fisch Type A technique can be used to access pathologies in this region without sacrificing conductive hearing or facial nerve function. Three dimensional operatively oriented neuroanatomy dissections provide surgeons with a valuable resource for learning this complex surgical approach.
Identifiants
pubmed: 37976145
doi: 10.1227/ons.0000000000000996
pii: 01787389-990000000-00971
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
452-462Informations de copyright
Copyright © Congress of Neurological Surgeons 2023. All rights reserved.
Références
Fisch U, Pillsbury HC. Infratemporal fossa approach to lesions in the temporal bone and base of the skull. Arch Otolaryngol. 1979;105(2):99-107.
Fisch U, Fagan P, Valavanis A. The infratemporal fossa approach for the lateral skull base. Otolaryngol Clin N Am. 1984;17(3):513-552.
Sanna M, De Donato G, Taibah A, Russo A, Falcioni M, Mancini F. Infratemporal fossa approaches to the lateral skull base. Keio J Med. 1999;48(4):189-200.
Taylor RJ, Patel MR, Wheless SA, et al. Endoscopic endonasal approaches to infratemporal fossa tumors: a classification system and case series. Laryngoscope. 2014;124(11):2443-2450.
Zanoletti E, Martini A, Emanuelli E, Mazzoni A. Lateral approaches to the skull base. Acta Otorhinolaryngol Ital. 2012;32(5):281-287.
Moody-Antonio S. Atlas of skull base surgery and neurotology. Otol Neurotol. 2009;30(6):695.
Kockro RA, Schwandt E, Ringel F, Eisenring CV, Nowinski WL. Operative anatomy of the skull base: 3D exploration with a highly detailed interactive atlas. J Neurol Surg B Skull Base. 2022;83(Suppl 2):e298-e305.
Leonel LCP, Carlstrom LP, Graffeo CS, et al. Foundations of advanced neuroanatomy: technical guidelines for specimen preparation, dissection, and 3D-photodocumentation in a surgical anatomy laboratory. J Neurol Surg B Skull Base. 2021;82(Suppl 3):e248-e258.
Gjuric M, Bilic M. Transmastoid-infralabyrinthine tailored surgery of jugular paragangliomas. Skull Base. 2009;19(1):75-82.
Brackmann DE. The facial nerve in the infratemporal approach. Otolaryngol Head Neck Surg. 1987;97(1):15-17.
Martin C, Prades JM. Removal of selected infralabyrinthine lesions without facial nerve mobilization. Skull Base Surg. 1992;2(4):220-226.
Pensak ML, Jackler RK. Removal of jugular foramen tumors: the fallopian bridge technique. Otolaryngol Head Neck Surg. 1997;117(6):586-591.