Surgical Strategy for Tumors Located in or Extending From the Intracranial Space to the Infratemporal Fossa : Advantages of the Transcranial Approach (Zygomatic Infratemporal Fossa Approach) and the Indications for a Combined Transcranial and Transcervica
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概要
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The surgical strategy for tumors located in or extending from the intracranial space to the infratemporal fossa was analyzed in 12 cases with various pathologies. A case of mandibular nerve schwannoma, which extended 1 cm below the external orifice of the foramen ovale, was completely removed via the epidural subtemporal approach without zygomatic osteotomy with partial removal of the middle cranial base. The inferior margin of infratemporal tumor could be accessed via the transcranial route with zygomatic or orbitozygomatic osteotomy without complications including facial nerve injury in nine cases, and the lowest level of the infratemporal tumors was approximately 4.5 cm below the outer surface of the middle cranial base. In five of these 9 cases (2 schwannomas, 1 myxoma, 1 chondrosarcoma, and 1 malignant peripheral nerve sheath tumor), the tumors were localized in the infratemporal fossa, and in the other 4 cases (2 meningiomas, 1 glioblastoma, and 1 ameloblastoma), the tumors extended to both the intracranial space and the infratemporal fossa. In two cases (recurrent jugular schwannoma and mandibular osteosarcoma), a combined transcranial and transcervical approach (mandibular swing approach) was essential, because the resection line of the lower margin was too far from the middle cranial base. These results indicate that the transcranial approach, with or without zygomatic or orbitozygomatic osteotomy (zygomatic infratemporal fossa approach), is safe and effective for removal of some infratemporal tumors, and that a combined transcranial and transcervical approach is useful for removing infratemporal tumors with extensive downward extension.
- 社団法人 日本脳神経外科学会の論文
- 2009-12-15
著者
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YOSHIDA Kazunari
Department of Neurosurgery, Keio University School of Medicine
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KAWASE Takeshi
Department of Neurosurgery, Keio University School of Medicine
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Yago Kaori
Department Of Dentistry And Oral Surgery Keio University School Of Medicine
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TOMITA Toshiki
Department of Otolaryngology, School of Medicine, Keio University
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Tomita Toshiki
Department Of Otolaryngology Keio University School Of Medicine
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Kawase Takeshi
Department Of Chemistry Graduate School Of Science Osaka University
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OGAWA KAORU
Department of Internal Medicine, Juntendo Izunagaoka Hospital
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KAWANA Hiromasa
Department of Dentistry and Oral Surgery, Keio University School of Medicine
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ASANAMI Soichiro
Department of Dentistry and Oral Surgery, Keio University School of Medicine
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Yoshida Kazunari
Department Of Neurosurgery Keio University School Of Medicine
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Ogawa Kaoru
Department Of Internal Medicine Juntendo Izunagaoka Hospital
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Ogawa Kaoru
Department Of Otolaryngology Keio University School Of Medicine
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Kawana Hiromasa
Department Of Dentistry And Oral Surgery Keio University School Of Medicine
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Asanami Soichiro
Department Of Dentistry And Oral Surgery Keio University School Of Medicine
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Kawase Takeshi
Department Of Chemistry Faculty Of Science Osaka University
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Ogawa Kaoru
Department of Chemical Engineering, Tokyo Institute of Technology
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