Guinto Gerardo, Hernandez Eli, Gallardo-Ceja David, Gallegos-Hernandez Francisco, Arechiga Norma, Guinto-Nishimura Gerardo
Department of Neurosurgery, Centro Medico ABC, Mexico DF, Mexico.
Department of Neurosurgery, Hospital Angeles del Pedregal, Mexico DF, Mexico.
J Neurol Surg B Skull Base. 2021 May 3;83(Suppl 3):e646-e647. doi: 10.1055/s-0041-1727125. eCollection 2022 Aug.
Tumor growth in infratemporal fossa (ITF) and parapharyngeal space (PPS) is generally slow and generates very few clinical manifestations, so it is not uncommon for tumors to reach large dimensions at the time of diagnosis, making necessary to perform ample approaches. In zygomatic-transmandibular approach (ZTMA), the access of the ITF and PPS is obtained by a combination of a pterional craniotomy plus a zygomatic-mandibular osteotomy. Tumor excision is achieved by its initial dissection from all of the neurovascular structures of the middle fossa by the neurosurgical team and the final resection by the head and neck team from below. In the first part of this video, we present a brief anatomical-surgical description of the ITF and PPS and in the second part, we show case of a trigeminal schwannoma that could be successfully removed through a ZTMA. Using this approach, an ample and safe exposure of the ITF and PPS is achieved, without affecting the chewing or facial nerve function and with excellent cosmetic results, so it can be considered as a reliable surgical option, particularly in cases of giant tumors that affect these regions ( Figs. 1 and 2 ). The link to the video can be found at: https://youtu.be/oxVFhzT8HsQ .
颞下窝（ITF）和咽旁间隙（PPS）的肿瘤生长通常较为缓慢，产生的临床表现很少，因此肿瘤在诊断时达到较大尺寸并不罕见，这使得有必要采取充分的手术入路。在颧-下颌入路（ZTMA）中，通过翼点开颅术和颧-下颌截骨术相结合的方式进入ITF和PPS。肿瘤切除首先由神经外科团队从中颅窝的所有神经血管结构开始进行分离，最后由头颈外科团队从下方完成切除。在本视频的第一部分，我们对ITF和PPS进行简要的解剖学-手术描述，在第二部分，我们展示一例通过ZTMA成功切除的三叉神经鞘瘤病例。采用这种入路，可以充分且安全地暴露ITF和PPS，不影响咀嚼或面神经功能，且美容效果极佳，因此它可被视为一种可靠的手术选择，尤其是对于影响这些区域的巨大肿瘤病例（图1和图2）。视频链接可在以下网址找到：https://youtu.be/oxVFhzT8HsQ 。
