Infratemporal fossa approach to tumours of the temporal bone and base of the skull

Infratemporal fossa approach to tumours of the temporal bone and base of the skull* By U. FISCH (Zurich) IN spite of the translabyrinthine and middle cranial fossa approaches, tumours situated in the infralabyrinthine and apical regions of the pyramid and surrounding portions of the base of the skull remain a surgical challenge for neurosurgeons and otolaryngologists as well.The transpalataltranspharyngeal route proposed by Mullan et al. (1966) and the transcochlear approach of House and Hitselberger (1976) do not provide adequate exposure for large glomus jugulare tumours, clivus chordomas, cholesteatomas and carcinomas invading the pyramid tip and skull base.The proper management of these lesions requires a larger approach permitting exposure of the internal carotid artery from the carotid foramen to the cavernous sinus (Fig. 1).The infratemporal fossa exposure presented in this paper is a possible solution to this problem.The basic features of the proposed lateral approach to the skull base are: (a) the permanent anterior displacement of the facial nerve, (b) the subluxation or permanent resection of the mandibular condyle, (c) the temporary displacement of the zygomatic arch, and (d) the subtotal petrosectomy with obliteration of the middle ear cleft.Three different types of infratemporal fossa approach have developed from the experience gained in 51 patients.They will be described and illustrated with typical cases. Surgical techniqueThe realization of the infratemporal fossa approach to the pyramid tip and base of the skull has been hampered by difficulties in handling the following structures (Fig. 2): (a) the facial nerve, (b) the mandibular * Based on the Toynbee Memorial Lecture delivered at the Royal College of Surgeons on 4 May 1978.