Pieper D R, Al-Mefty O
Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, USA.
Neurosurgery. 1999 Aug;45(2):231-7; discussion 237-8. doi: 10.1097/00006123-199908000-00005.
Intracranial meningiomas extending into the infratemporal fossa (ITF) are uncommon. This series describes the radiographic characteristics, histological pattern of invasion, and implications for surgical treatment of intracranial meningiomas.
Nine patients (median age, 52 yr) underwent resection of a transcranial meningioma extending into the ITF. Five patients (56%) had undergone a previous resection; however, none had involvement of the ITF. Four patients (44%) had received prior radiation therapy to the area.
Preoperative neuroradiography uniformly showed erosion of the middle fossa floor and extension of the tumor through cranial base foramina. Histological results indicated tumor invasion of the middle fossa floor and skeletal muscle in all patients. Perineural invasion was present in four patients. Mucosal invasion was observed in six patients. A middle fossa/zygomatic approach provided access to the intra- and extracranial components of the tumor, as well as the cavernous sinus, ITF structures, paranasal sinuses, and nasopharynx. Reconstruction was performed using the temporalis muscle, which provides a vascularized flap between exposed mucosa and the carotid artery and intradural structures. A gross total resection was performed in seven patients (78%). Postoperative complications included soft tissue ischemia (one patient), worsening of preoperative cranial neuropathy (two patients), and lower extremity deep vein thrombosis (two patients). One patient died 2 months postoperatively from a pulmonary embolus. Two patients had recurrence of intracranial meningiomas extending into the ITF at 2 and 3 years postoperatively, necessitating further resection.
Understanding the pertinent clinical and morphological aspects of meningioma transcranially involving the ITF is essential to surgical treatment of patients with this condition.
颅内脑膜瘤延伸至颞下窝（ITF）并不常见。本系列研究描述了颅内脑膜瘤的影像学特征、侵袭的组织学模式及其对手术治疗的意义。
9例患者（中位年龄52岁）接受了经颅切除延伸至ITF的脑膜瘤手术。5例患者（56%）曾接受过手术切除，但均未累及ITF。4例患者（44%）曾接受过该区域的放疗。
术前神经影像学检查均显示中颅窝底骨质侵蚀以及肿瘤经颅底孔道延伸。组织学结果表明所有患者的肿瘤均侵袭了中颅窝底和骨骼肌。4例患者存在神经周围侵袭。6例患者观察到黏膜侵袭。中颅窝/颧弓入路可显露肿瘤的颅内和颅外部分、海绵窦、ITF结构、鼻窦和鼻咽部。使用颞肌进行重建，颞肌可在暴露的黏膜与颈动脉及硬膜内结构之间提供带血管蒂皮瓣。7例患者（78%）实现了肿瘤全切除。术后并发症包括软组织缺血（1例患者）、术前颅神经病变加重（2例患者）和下肢深静脉血栓形成（2例患者）。1例患者术后2个月死于肺栓塞。2例患者术后2年和3年出现颅内脑膜瘤复发并延伸至ITF，需要进一步切除。
了解经颅累及ITF的脑膜瘤的相关临床和形态学特征对于该疾病患者的手术治疗至关重要。
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