| Home | E-Submission | Sitemap | Editorial Office |  
top_img
Journal of Korean Neurosurgical Society 2001;30(9): 1079-1085.
Surgical Approaches to the Middle Cranial Base Tumors.
Il Seub Kim, Hyung Kyun Rha, Kyung Jin Lee, Kyung Keun Cho, Sung Chan Park, Hae Kwan Park, Jeung Keun Cho, Jun Ki Kang, Chang Rhack Choi
1Department of Neurological Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.
2Department of Catholic Neuroscience Center, College of Medicine, The Catholic University of Korea, Seoul, Korea.
ABSTRACT
OBJECTIVE
We analysed various surgical approaches and surgical results of 28 middle cranial base tumors for the purpose of selecting optimal surgical approach to the middle cranial base tumor.
METHODS
In this retrospective review, 28 patients, including 16 meningioma, 6 trigeminal neurinoma, 2 pituitary adenoma, 2 craniopharyngioma, 1 facial neurinoma, and 1 metastatic tumor, underwent surgical treatment using skull base technique. Of theses, 16 tumors were mainly confined to middle cranial fossae, 5 tumors with extension into both anterior and middle fossa, and 7 tumors with extension into both middle and posterior fossa. Tumors that confined to the middle cranial fossa or extended into the anterior cranial fossa were operated with modified pterional, orbitozygomatic or Dolen'c approach, and tumors that extended into the posterior cranial fossa were operated with anterior, posterior or combined transpetrosal approach. Completeness of tumor resection, surgical outcome, postoperative complication, and follow up result were studied.
RESULTS
Total tumor removal was achieved in 9 tumors of 10 tumors that did not extended to the cavernous sinus, and was achieved in 7 tumors of 8 tumors that extended to the lateral wall of the cavernous sinus. Of 10 tumors that extended to the venous channel of the cavernous sinus, only 2 were removed totally. Surgical outcome was excellent in 14 patients, good in 10, fair in 2 and poor in 2. There were no death in this series. Dumbell type tumor which extended into both middle and posterior fossae showed tendency of poor prognosis as compared with tumors that confined middle cranial fossa and extended into both anterior and middle cranial fossa. Postoperative dysfunctions were trieminal hypesthesia in 3, oculomotor nerve palsy in 2, abducens nerve palsy in 2, hemiparesis in 2, cerebellar sign in 1, facial palsy in 1 and hearing impairment in 1.
CONCLUSION
Based on our findings and a review of the literature, we conclude that, when selecting the surgical approach to the middle cranial fossa tumors, the most important factors to be considered were exact location of the tumor mass and existence of the cavernous sinus invasion by tumor mass. We recommend modified pterional or orbitozygomatic approach in cases with tumors located anterior and middle cranial base, without cavernous sinus invasion. In cases with tumors invading into cavernous sinus, we recommend Dolen'c or orbitozygomatic approach. And in lateral wall mass and the cavernous sinus, it is preferred to approach the tumor extradurally. For the tumor involing with middle fossa and posterior fossa(dumbell type) a combined petrosal approach is necessary. In cases with cavernous sinus invasion and internal carotid artery encasement, we recommend subtotal resection of the tumor and radiation therapy to prevent permanent postoperative sequele.
Key Words: Middle cranial fossa; Cavernous sinus; Dumbell type; Surgical approach
TOOLS
Full text via DOI  Full text via DOI
Download Citation  Download Citation
Share:      
METRICS
1,939
View
79
Download
Related articles
Clinical Observation on the Pineal Tumors.  1979 September;8(2)
A Case of Arachnoid Cyst in the Middle Cranial Fossa.  1980 March;9(1)
Surgical Approach to the Juxtasellar Meningioma.  1981 March;10(1)
Microvascular Decompression of the Fifth and Seventh Cranial Nerves.  1981 March;10(1)
Two Cases of Arachnoid Cyst of the Middle Cranial Fossa.  1983 December;12(4)
Editorial Office
1F, 18, Heolleung-ro 569-gil, Gangnam-gu, Seoul, Republic of Korea
TEL: +82-2-525-7552   FAX: +82-2-525-7554   E-mail: kns61@neurosurgery.or.kr
About |  Browse Articles |  Current Issue |  For Authors and Reviewers
Copyright © Korean Neurosurgical Society.                 Developed in M2PI
Close layer