Tumors of the Temporal Base and Infratemporal Fossa: Suitability of the Preauricular Approach

• Main Authors: Lehmberg, J., Török, E., Krieg, S.
• Format: Conference Proceeding
• Language: English
• ISSN: 2193-6331; 2193-634X
• DOI: 10.1055/s-0032-1314254

Objective: The classic neurotology approach to the infratemporal fossa includes a more or less extended petrosectomy. The neurosurgical approach preserves the petrous bone and has a more anterior trajectory. Design: Description of the experience with the preauricular approach. Methods: Ten patients with tumors extending into the infratemporal fossa were operated on between 2007 and 2011. A single temporal craniotomy was performed in five, zygomatic osteotomy in four, and an orbitozygomatic osteotomy was added in one case. There were two meningiomas, two neurinomas, one hemangiopericytoma, one juvenile angiofibroma, one giant cell tumor, two adenoid cystic carcinomas, and one osteosarcoma. Duraplasty was formed in 7/10 cases. Results: A temporal craniotomy alone without osteotomy was applied if a large part of the tumor was found intracranially. An osteotomy of the zygoma allowed the dislocation of the temporal muscle, reducing the need for temporal lobe retraction. Therefore, this osteotomy was applied in cases without a large intracranial tumor mass. Gross total resection was achieved in the meningioma, neurinoma, giant cell tumor, and adenocystic carcinoma cases. As intended, a partial resection was achieved in the juvenile angiofibroma case. In the osteosarcoma case, a tumor remnant was found in the sphenoid sinus. One CSF leak stopped after 4 days of lumbar drainage without revision surgery. Conclusions: Preauricular skin incision followed by temporal craniotomy and craniectomy of the temporal base is a suitable approach for tumors of the temporal base extending into the infratemporal fossa. Zygomatic osteotomy should be considered liberally to minimize the need for temporal lobe retraction.