Taniguchi Seika, Kam Jeremy, Castle-Kirszbaum Mendel, Akagami Ryojo
1Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
2Department of Neurosurgery, Vancouver General Hospital, Vancouver, British Columbia, Canada; and.
J Neurosurg. 2024 Oct 18;142(3):731-740. doi: 10.3171/2024.6.JNS232959. Print 2025 Mar 1.
With the capacity to provide maximal lesion exposure, the subtemporal preauricular infratemporal (SPI) approach with condylar fossa osteotomy is highly utilized in radical resection of skull base tumors. While this approach requires disruption of the temporomandibular joint (TMJ) for access, the effects of this maneuver are poorly appreciated in neurosurgery. The aim of this study was to assess the morbidity of condylar fossa osteotomies by comparing oral health quality of life (OHQOL) and general health quality of life (GHQOL) outcomes after TMJ-involving and TMJ-sparing skull base approaches.
A retrospective review of the medical records of patients who underwent surgery with the SPI approach (TMJ-involving approach) for skull base chondrosarcoma (CS) by a single senior surgeon at Vancouver General Hospital between 2002 and 2022 was performed. Patients undergoing TMJ-sparing anterolateral approaches for trigeminal schwannoma (TS) during the same study period by the same surgeon were included as controls. GHQOL was evaluated using the 36-item Short Form Health Survey from preoperative and postoperative periods. Postoperative OHQOL was evaluated using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Axis I/II screening instrument.
Data regarding quality of life were available for 13 of 19 CS patients and 12 of 15 TS patients surgically managed between 2002 and 2022. CS patients demonstrated less jaw dysfunction in all parameters of the DC/TMD Axis I/II components when specifically assessing OHQOL. CS patients had a lower likelihood of temporomandibular disorder (TMD) presence on the TMD pain screener than TS patients (25% vs 45%, p = 0.40). Chronic pain scores were higher in the TS group, with significantly more patients with grade 2 or higher pain (36.4% vs 0%, p = 0.01). The mean Jaw Functional Limitation Scale (JFLS) scores were lower in CS patients than in TS patients. Both CS and TS patients demonstrated lower mean JLFS scores (0.50 and 0.81, respectively) than patients with chronic TMD (1.76), but higher mean JLFS scores than patients without TMD (0.16).
The authors report novel findings regarding the impact of the SPI approach with a condylar fossa osteotomy on OHQOL and GHQOL among skull base tumor patients. Anatomical disruption of the TMJ was not associated with significant clinical TMJ dysfunction. Compared with TS patients, CS patients had even lower mean scores in TMJ-related morbidity, and both groups had lower TMJ morbidity than patients diagnosed with chronic TMJ dysfunction. Condylar fossa osteotomies can therefore be considered without concern of significant additional morbidity.
颞下耳前颞下（SPI）入路结合髁状窝截骨术能够最大程度暴露病变，在颅底肿瘤根治性切除中应用广泛。虽然该入路需要破坏颞下颌关节（TMJ）以获得手术通道，但神经外科领域对这一操作的影响了解不足。本研究旨在通过比较涉及TMJ和不涉及TMJ的颅底手术入路术后的口腔健康相关生活质量（OHQOL）和总体健康相关生活质量（GHQOL）结果，评估髁状窝截骨术的并发症发生率。
对2002年至2022年期间在温哥华总医院由同一位资深外科医生采用SPI入路（涉及TMJ的入路）进行颅底软骨肉瘤（CS）手术的患者病历进行回顾性分析。同一时期由该外科医生采用保留TMJ的前外侧入路治疗三叉神经鞘瘤（TS）的患者作为对照。术前和术后使用36项简短健康调查问卷评估GHQOL。术后使用颞下颌关节紊乱病诊断标准（DC/TMD）轴I/II筛查工具评估OHQOL。
2002年至2022年期间接受手术治疗的19例CS患者中有13例、15例TS患者中有12例可获得生活质量数据。在专门评估OHQOL时，CS患者在DC/TMD轴I/II各组成部分的所有参数中显示出较少的颌功能障碍。在TMD疼痛筛查中，CS患者患颞下颌关节紊乱病（TMD）的可能性低于TS患者（25%对45%，p = 0.40）。TS组的慢性疼痛评分更高，疼痛分级为2级或更高的患者明显更多（36.4%对0%，p = 0.01）。CS患者的平均颌功能受限量表（JFLS）评分低于TS患者。CS和TS患者的平均JLFS评分均低于慢性TMD患者（分别为0.50和0.81），但高于无TMD患者（0.16）。
作者报告了关于SPI入路结合髁状窝截骨术对颅底肿瘤患者OHQOL和GHQOL影响的新发现。TMJ的解剖结构破坏与明显的临床TMJ功能障碍无关。与TS患者相比，CS患者在TMJ相关并发症方面的平均得分更低，且两组的TMJ并发症发生率均低于诊断为慢性TMJ功能障碍的患者。因此，可以考虑进行髁状窝截骨术，而无需担心会显著增加额外的并发症发生率。
