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Journal of Korean Neurosurgical Society > Volume 25(8); 1996 > Article
Journal of Korean Neurosurgical Society 1996;25(8): 1591-1601.
Improved Access to Skull Base Tumors by Resection of the Zygoma.
Jung Hoon Kim, Chang Jin Kim, C Jin Whang
Department of Neurological Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
Improved access to lesions at the medial end of the sphenoid ridge, in the cavernous sinus, or in the interpeduncular cistern after mobilization of the zygoma has been a subject of growing interest in recent years. This study described out experience with 23 patients who underwent the zygomatic osteotomy for skull base tumors in the past 6 years. The follow-up period ranged from 5 months to 49 months. The patient' age range was 11 to 75 years, with an average age of 45 years. This zygomatic osteotomy was used from eleven patients with medial sphenoid ridge lesions, six with lesions arising in or involving the cavernous sinus, three with clival lesions, two with sellar/parasellar lesions, and one with temporal lobe lesions. The histology of these patients showed fourteen meningiomas, two pituitary adenomas, two chordomas, one neurinoma, one chondrosarcoma, one osteochondroma, one malignant lymphoma, and one dermoid cyst. Surgical treatment consisted of total removal in ten patients, subtotal removal in twelve, and partial removal in one. Instances of morbidities associated with basic lesions included cranial nerve injury in five patients, hemorrhage/infarction in three, hemiparesis in two, and transient aphasia in one. There were no significant problems related to zygomatic osteotomy. One patient who underwent zygomatic osteotomy for medial sphenoid ridge meingioma developed a frontalis nerve injury. No patient experienced a detachment of zygomatic arch in our series. Postoperatively, one patient with parasellar malignant lymphoma died 14 months after surgery from tumor progression. Our cases treated via this zygomatic osteotomy are as yet insufficient to determine whether the method offers definite adventages, in terms of patient mortality and morbidity, over conventional operative approaches, but we suggest that this procedure has some advantages such as minimal brain retraction, exposure of lesion in shortest distance, multidirectional viewing of the lesions, and can serve as an alternative approach to a usual pterional approach when cranial base pathologies are large or complex.
Key Words: Zygomatic osteotomy; Skull base tumors; Pterional approach; Morbidity; Advantages
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