J Neurol Surg B Skull Base 2019; 80(S 01): S1-S244
DOI: 10.1055/s-0039-1679720
Poster Presentations
Georg Thieme Verlag KG Stuttgart · New York

The Extended Middle Cranial Fossa Approach for the Treatment of Skull Base Lesions

Noga Lipschitz
1   Department of Otolaryngology – Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
,
Gavriel D Kohlberg
1   Department of Otolaryngology – Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
,
Joseph T. Breen
1   Department of Otolaryngology – Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
,
Myles L. Pensak
1   Department of Otolaryngology – Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
,
Mario Zuccarello
2   Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
,
Noerberto Andaluz
3   Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, United States
,
Vincent A. Dinapoli
4   Mayfield Clinic, Cincinnati, Ohio, United States
,
Ravi N. Samy
1   Department of Otolaryngology – Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
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Publikationsdatum:
06. Februar 2019 (online)

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Background: The extended middle cranial fossa (xMCF) approach provides expanded surgical exposure compared with the standard MCF approach. It is used to access posterior fossa pathologies and consists of a MCF craniotomy followed by modular expansions that include anterior petrosectomy, internal auditory canal (IAC) exposure, translabyrinthine exposure and posterior petrosectomy, based on the pathology, size, and location of the lesion.

Objective: To review the clinical indications and surgical outcomes of patients undergoing xMCF approach for the treatment of skull base lesions.

Methods: Retrospective chart review of patients undergoing xMCF approach for resection of skull base lesions between 2007 and 2017 in a tertiary referral academic center.

Results: Twenty-three patients underwent xMCF approach during the study period. Meningioma was the most common indication (14 patients, 61%), followed by epidermoid cyst (3 patients, 13%), vestibular schwannoma (3 patients, 13%) and other indications (3 patients, 13%). Three cases were revision surgeries after prior resection, and 3 patients received prior radiation. Three cases were part of a staged operation. Mean tumor diameter was 34.2 mm (range: 18–60 mm). Twenty patients (87%) had preoperative grade 1 House–Brackmann (HB) facial nerve function; of those, 14 patients (70%) had postoperative HB grade 1. There was no postoperative mortality. Major complications included subarachnoid hemorrhage secondary to vertebral artery pseudoaneurysm in a patient with giant petroclival meningioma, middle cerebral artery (MCA) stroke in one patient, and transverse sinus thrombosis in one patient. There was one case (4.3%) of postoperative CSF leak. Mean follow-up was 6.5 months (range: 0.25–37 months). The modified Rankin scale was used for postoperative outcome assessment. A score of 0 to 2 was present in 19 patients (83%), and the remaining 4 patients (17%) had scores of 3 to 4. No patients had scores of 6 to 5.

Conclusion: The xMCF is approach is an important tool for the treatment of difficult to access or large lesions with good outcomes. It can also be used in patients with prior surgery or after prior radiation therapy. However, as for any large intracranial mass or lesion approached by a variety of skull base approaches, there is the potential risk of intracranial complications.