Department of Neurosurgery, Università Politecnica delle Marche, Azienda Ospedali Riuniti, Ancona, Italy.
Department of Oral and Maxillo-facial Surgery, Università Politecnica delle Marche, Azienda Ospedali Riuniti, Ancona, Italy.
Neurol Neurochir Pol. 2022;56(2):178-186. doi: 10.5603/PJNNS.a2022.0023. Epub 2022 Mar 18.
Tumours of the infratemporal fossa (ITF) are rare and include primary tumours, contiguity lesions and metastases. Surgical resection is the gold standard. The fronto-orbito-zygomatic (FOZ) approach is commonly used in order to obtain safe access to the lateral skull base and ITF to resect intra- and extra-cranial tumours. We here describe our series of ITF lesions extending to the middle cranial fossa and/or orbit, treated by single- or two piece FOZ.
All cases of single- or two-piece FOZ approach for an infratemporal fossa lesion extending to the middle cranial fossa operated at our Institution from January 2014 to January 2018 were retrospectively reviewed. The follow-up was for a minimum of four months and a maximum of 60 months. The inclusion criteria were lesions involving the ITF with an extension to the middle cranial fossa and/or orbit. Baseline characteristics of patients, tumour localisation, tumour extension, diffusion route, histology, extent of tumour resection, postoperative treatment, and post-operative complications were evaluated.
Nine patients underwent a surgical procedure with a FOZ approach, two of them with a single-piece approach and the remainder with a two-piece one. All patients had an ITF localisation. Gross total removal (GTR) was achieved in 7/9 patients. Only one patient, with non-total removal (NTR), underwent radiotherapy.
For the treatment of ITF fossa tumours extending to the orbit and or middle cranial fossa, we believe that both FOZ techniques are effective and allow a good medial extension toward the cavernous sinus and parasellar region. But a two-piece craniotomy may ensure a more medial extension and a wider angle of work compared to a one-piece craniotomy.
颞下窝（ITF）肿瘤较为罕见，包括原发性肿瘤、毗邻性病变和转移瘤。手术切除是金标准。额眶颧（FOZ）入路常用于安全地到达颅底外侧和 ITF，以切除颅内和颅外肿瘤。我们在此描述了我们一系列的 ITF 病变延伸至中颅窝和/或眼眶，采用单或双块 FOZ 治疗。
回顾性分析了 2014 年 1 月至 2018 年 1 月期间我院采用单或双块 FOZ 入路治疗 ITF 病变延伸至中颅窝的病例。随访时间至少为 4 个月，最长为 60 个月。纳入标准为累及 ITF 并延伸至中颅窝和/或眼眶的病变。评估患者的基线特征、肿瘤定位、肿瘤延伸、扩散途径、组织学、肿瘤切除范围、术后治疗和术后并发症。
9 例患者接受了 FOZ 入路手术，其中 2 例采用单块入路，其余 7 例采用双块入路。所有患者均位于 ITF。7/9 例患者实现了大体全切除（GTR）。仅 1 例非全切除（NTR）患者接受了放疗。
对于治疗延伸至眶和/或中颅窝的 ITF 窝肿瘤，我们认为 FOZ 两种技术均有效，可实现良好的向海绵窦和鞍旁区域的内侧延伸。但与单块开颅术相比，双块开颅术可能确保更内侧的延伸和更宽的工作角度。
