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Journal of Neurosurgical Sciences 2003 September;47(3):141-7

lingua: Inglese

Fronto-tem­po­ro-orbi­to-zygo­mat­ic ­approach and var­i­ants. Surgical tech­nique and indi­ca­tions

Santoro A. 1, Salvati M. 2, Vangelista T. 2, Delfini­ R. 1, Cantore G. P. 2

1 Division of Neurosurgery, Department of Neurosurgical Sciences, “La Sapienza” University, Rome, Italy,
2 Department of Neurosurgery, INM Neuromed IRCCS, Pozzilli, Italy


Aim. In the ­last ­decade, devel­op­ment and ­refìnement of ­skull ­base sur­gery ­have wid­ened the sur­gi­cal ­options avail­able for treat­ment of mtrac­ra­mal ­lesions. Despite the enor­mous advanc­es ­made m micro­sur­gi­cal tech­nique, the ­bony ­phase is ­still extreme­ly impor­tant for ­achievmg opti­mal expo­sure of vas­cu­lar and tumo­ral ­skull ­base ­lesions. The ­role of ante­ro­lat­er­al approach­es for ­such ­lesions is dis­cussed.
Methods. We col­lect­ed 87 con­sec­u­tive ­patients ­with 74 neo­plasms and 13 vas­cu­lar ­lesions involv­ing the ­floor of the ant­en­or and/or mid­dle cra­ni­al fos­sae, cav­ern­ous ­sinus, ­orbit, ­petrous ­bone, cli­vus, par­a­sel­lar ­region and infra­tem­po­ral fos­sa oper­at­ed through­out 8 and a ­half ­years by ­means of an ante­ro­lat­er­al ­approach and we eval­u­at­ed the ­results ­obtained employ­ing dif­fer­ent cran­i­ot­o­mies.
Results. To sim­pli­fy the param­e­ters for eval­u­a­tion of out­come, we con­sid­ered 2 ­main ­aspects: com­par­i­son ­between pre- and post­op­er­a­tive neu­ro­log­i­cal stat­us and the ­extent of ­tumour remov­al on MR imag­ing. For vas­cu­lar ­lesions, we ­took ­into con­sid­er­a­tion the neu­ro­log­i­cal out­come and the suc­cess­ful clip­ping of the aneu­rysm or dis­ap­pear­ance of the AVM (l ­case) on post­op­er­a­tive angio­gra­phy. Satisfactory sur­gi­cal ­results ­were ­obtained ­with ­each ­type of cran­i­ot­o­my ­employed (fron­to-ten­i­po­ro-orbi­to-zygo­mat­ic, fron­to-tem­po­ro-orbi­tal, fron­to-tem­po­ro-zygo­mat­ic, fron­to-orbi­to-zygo­mat­ic).
Conclusion. On the ­whole, sur­gi­cal ­results ­were sat­is­fac­to­ry. By delib­er­ate­ly exclud­ing the micro­sur­gi­cal ­aspects of the ­lesions treat­ed, we can ­observe ­that the fron­to-tem­po­ro-orbi­to-zygo­mat­ic ­approach is prin­ci­pal­ly indi­cat­ed for ­lesions requir­ing a mul­ti­di­rec­tion­al ­approach ­such as sphe­no-­petro-cli­val ­tumours, aneu­rysms of the bas­i­lar tip and intra­cav­e­mous ­lesions ­while the fron­to-tem­po­ro-orbi­tal ­approach ­proved excel­lent for ­more medi­al ­lesions ­such as menin­gio­mas of the luber­cu­lum sel­lae and cra­moph­a­ryn­gio­mas. The fron­to-tem­po­ro-zygo­mat­ic ­approach is our 1st ­choice for neo­plasms involv­ing the Gassenan gan­gli­on and the intra­tem­po­ral fos­sa. For ­lesions of the orbi­tal ­apex, a fron­to-orbi­to-zygo­mat­ic ­approach can be suc­cess­ful­ly ­employed. Introduction of ­these approach­es is rel­a­tive­ly ­recent but prom­is­es a fur­ther refine­ment of ­their indi­ca­tions and sur­gi­cal tech­nique ­aimed at mim­mismg post­op­er­a­tive mor­bid­ity.

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