Maxillary Swing Approach for Central Skull Base Lesions in Extreme Situations: A Single-Institutional Case Series

• Published in: World neurosurgery 2022-10, Vol.166, p.e337-e344
• Main Authors: Zuo, Fuxing, Ye, Shilu, Qian, Haipeng, Liu, Shaoyan, Wan, Jinghai
• Format: Article
• Language: English
• Subjects: Central skull base; Humans; Lesion characteristics; Maxillary swing approach; Meningeal Neoplasms - diagnostic imaging; Meningeal Neoplasms - pathology; Meningeal Neoplasms - surgery; Neoplasm Recurrence, Local - pathology; Retrospective Studies; Skull Base - pathology; Skull Base - surgery; Skull Base Neoplasms - diagnostic imaging; Skull Base Neoplasms - pathology; Skull Base Neoplasms - surgery
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2022.07.009

Radical resection of complex lesions occupying multiple compartments at the central skull base remains a significant challenge, since surgical outcomes may be compromised by insufficient exposure and inappropriate techniques. However, the efficiency of the maxillary swing approach for these lesions has not been sufficiently evaluated. Careful assessment of lesion characteristics must be performed when selecting the appropriate procedure. Between May 2006 and February 2017, 17 patients underwent resection of extensive lesions in the central skull base using the maxillary swing approach. As shown in the representative cases, data regarding clinical findings and technical considerations were reviewed. Complete resection was achieved in all patients. The pathological findings were diverse, and the majority were schwannomas (9 cases, 52.94%), followed by meningiomas (World Health Organization II) (3 cases, 17.65%). Complications were managed as described in the case illustrations, and symptoms improved with time. The follow-up duration ranged from 62 to 192 months (median, 114 months), while 2 patients were lost to the follow-up. No mortality was observed. Two patients who experienced malignancy relapse were still under observation due to their asymptomatic status. Our preliminary results suggest that the maxillary swing approach can be an alternative option for managing extreme cases, such as large, extensive, hypervascularized masses with fibrous or calcified consistency, or for recurrent lesions in the central skull base. En bloc resection can be successfully obtained, resulting in long-term local control.