Outcomes of Transzygomatic Middle Cranial Fossa Approach for Skull Base Tumors—A Single Institutional Experience

Abstract

Objective This study aimed to evaluate surgical outcomes after transzygomatic middle cranial fossa (MCF) (TZ-MCF) approach for tumor control in patients with large skull base lesions involving the MCF and adjacent sites.

Setting This study was done at the tertiary skull base center.

Design This is a retrospective case series.

Main Outcome Measures The main outcome measures were tumor control (recurrence), new-onset cranial neuropathies, facial nerve and audiometric outcomes, cerebrospinal fluid (CSF) leak, and wound complications.

Results Sixteen patients were identified with a median age of 45 years (range: 20–72). The mean maximum tumor dimension was 5.49 cm (standard deviation [SD]: 1.2, range: 3.1–7.3) and the mean tumor volume was 28.5 cm³ (SD: 18.8, range: 2.9–63.8). Ten (62.5%) tumors were left sided. The most common pathology encountered was meningioma (n = 7) followed by chondrosarcoma (n = 4). Mean follow-up was 36.3 (SD: 26.9) months. Gross total resection or near total resection was achieved in nine (56.2%) and planned subtotal resection was used in seven (43.7%). Postoperative additional new cranial nerve (CN) deficits included CN V (n = 1), CN III (n = 2), CN VI (n = 1), and CN X (n = 1). Major neurological morbidity (hemiplegia) was encountered in two patients with resolution. There were no cases of CSF leak, meningitis, hemorrhage, seizures, aphasia, or death. There was no recurrence or regrowth of residual tumor. Facial nerve function was preserved in all but one patient (House–Brackmann grade 2).

Conclusion Various skull base tumors involving MCF with extension to adjacent sites can be successfully resected using the TZ-MCF approach in a multidisciplinary fashion. This approach yields optimal exposure and permits excellent tumor control with acceptable CN and neurological morbidity.

Keywords

extended middle cranial fossa - meningioma - schwannoma - chondrosarcoma - facial nerve

Publication History

Received: 14 June 2019

Accepted: 14 February 2020

Article published online:
28 March 2020

• References

• 1 Lipschitz N, Kohlberg GD, Zuccarello M, Samy RN. Comprehensive review of the extended middle cranial fossa approach. Curr Opin Otolaryngol Head Neck Surg 2018; 26 (05) 286-292
• 2 Roche JP, Goates AJ, Hasan DM. et al. Treatment of lateral skull base and posterior cranial fossa lesions utilizing the extended middle cranial fossa approach. Otol Neurotol 2017; 38 (05) 742-750
• 3 Danner C, Cueva RA. Extended middle fossa approach to the petroclival junction and anterior cerebellopontine angle. Otol Neurotol 2004; 25 (05) 762-768
• 4 Kawase T, Shiobara R, Toya S. Middle fossa transpetrosal-transtentorial approaches for petroclival meningiomas. Selective pyramid resection and radicality. Acta Neurochir (Wien) 1994; 129 (3-4): 113-120
• 5 Kawase T, Toya S, Shiobara R, Mine T. Transpetrosal approach for aneurysms of the lower basilar artery. J Neurosurg 1985; 63 (06) 857-861
• 6 Chotai S, Kshettry VR, Petrak A, Ammirati M. Lateral transzygomatic middle fossa approach and its extensions: surgical technique and 3D anatomy. Clin Neurol Neurosurg 2015; 130: 33-41
• 7 Zhao JC, Liu JK. Transzygomatic extended middle fossa approach for upper petroclival skull base lesions. Neurosurg Focus 2008; 25 (06) E5
• 8 Son BC, Lee SW, Kim S, Hong JT, Sung JH, Yang SH. Transzygomatic approach with intraoperative neuromonitoring for resection of middle cranial fossa tumors. J Neurol Surg B Skull Base 2012; 73 (01) 28-35
• 9 Shen T, Friedman RA, Brackmann DE. et al. The evolution of surgical approaches for posterior fossa meningiomas. Otol Neurotol 2004; 25 (03) 394-397