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Burak Sade, Richard A. Prayson and Joung H. Lee

G liosarcomas are bimorphic intraaxial tumors consisting of malignant glial and sarcomatous components. They account for 2 to 8% of all malignant gliomas, 5 , 9 , 11 and their most common location has been reported to be the temporal lobe in 37.5 to 44% of the patients. 5 , 8 , 11 However, skull base involvement is highly unexpected, and we know of only one case that has been reported in the literature. 12 In the present report, we describe a case of gliosarcoma with significant infratemporal fossa extension. Case Report History and

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Gerald A. Grant, Mark H. Wener, Hadi Yaziji, Neal Futran, Mary P. Bronner, Neil Mandel and Marc R. Mayberg

microscopy. Urate crystals are needle shaped and intensely birefringent with a negative optic sign. Calcium pyrophosphate dihydrate crystals are somewhat rhomboid and display weakly positive birefringence; synovial fluid hydroxyapatite crystals are usually too small and amorphous to be detected by light microscopy, unless special calcium-binding stains such as alizarin red are used. We report a case of tumorlike calcium hydroxyapatite crystals arising in the infratemporal fossa of a woman with a clinical and morphological presentation identical to that previously described

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Mina M. Gerges, Saniya S. Godil, Iyan Younus, Michael Rezk and Theodore H. Schwartz

T he infratemporal fossa (ITF) is a deep quadrangular space that lies inferior to the middle cranial fossa. The boundaries of the ITF include the maxillary sinus anteriorly, greater wing of the sphenoid and temporal bone superiorly, lateral pterygoid plate and lateral wall of the pharynx medially, temporalis muscle laterally, and horizontal plane passing through the inferior border of the angle of the mandible inferiorly. There are a variety of benign and malignant pathologies that can involve the ITF. 33 Most neoplasms involving the ITF originate from adjacent

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Christoph P. Hofstetter, Ameet Singh, Vijay K. Anand, Ashutosh Kacker and Theodore H. Schwartz

) and third (V3) divisions of the trigeminal nerve and the vidian nerve (VN), often used as a landmark to identify the petrous internal carotid artery (ICA). PG = pituitary gland. Pterygopalatine, Infratemporal Fossa, Petrous Apex, and Meckel Cave Dissection The PPF can be largely divided into an anterior and posterior compartment. The anterior compartment contains fat and blood vessels, whereas the posterior compartment contains neural elements. 13 , 38 , 42 Gentle dissection of the fat reveals the vascular anatomy of the fossa. Distal branches of the internal

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Moran Amit, Diana Bell, Patrick J. Hunt, Ehab Hanna, Shirley Y. Su, Michael Kupferman, Mohamed Aashiq, Hideaki Takahashi, Paul W. Gidley, Marc-Elie Nader, Franco DeMonte and Shaan M. Raza

A nterolateral skull base malignancies with infratemporal fossa (ITF) involvement comprise a unique set of tumors with surgical considerations and histological diagnoses distinct from those for tumors of the central anterior skull base and temporal bone malignancies. The surgical challenges unique to the anterolateral skull base have been demonstrated in several key articles showing higher complication rates and reduced tumor control and survival rates. 1 The surgical challenges relate to the complexity of the ITF, its adjacent skull base, and intracranial

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James K. Liu, Kevin Zhao, Alejandro Vazquez and Jean Anderson Eloy

Transcript This is Dr. James Liu from Rutgers New Jersey Medical School. I will be demonstrating a combined endoscopic endonasal and sublabial transmaxillary approach for resection of a giant infratemporal fossa schwannoma with intracranial extension. 0:36 Patient history and physical examination The patient is a 44-year-old female who presented with progressive right eye proptosis and sinonasal obstruction associated with right visual loss and facial numbness in the right V2 and V3 region. Neuro-ophthalmologic exam showed a compressive right optic neuropathy

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Bruce Mickey, Lanny Close, Steven Schaefer and Duke Samson

upper aerodigestive tract, have been controlled by wide local excision when they are in purely extracranial locations. 7 By combining a neurosurgical exposure of the middle cranial fossa with an otolaryngological exposure of the infratemporal fossa, it is possible to provide simultaneous access to the intracranial and extracranial aspects of those tumors that involve the skull base in this region. Such an exposure permits accurate identification of the anterolateral and inferolateral margins of the cavernous sinus and facilitates the aggressive resection of these

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Laligam N. Sekhar, Victor L. Schramm Jr. and Neil F. Jones

paper we describe a combined subtemporal and preauricular infratemporal fossa approach to the middle and posterior skull base. This approach has been found useful for the removal of neoplasms involving the clivus, sphenoidal area, petrous apex, orbit, cavernous sinus, middle fossa, infratemporal fossa, and the retro- and parapharyngeal areas. It is a modification of previously described approaches, but has some advantages over the other techniques. The management of the petrous and upper cervical ICA and the reconstruction of extensive postoperative cranial base

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Tomasz Matys, Tariq Ali, Fulvio Zaccagna, Damiano G. Barone, Ramez W. Kirollos and Tarik F. Massoud

T he superior aspect of the infratemporal fossa is a region of considerable neurosurgical importance, containing branches of the mandibular nerve that exit the skull through the foramen ovale (FO). This region is traversed by two ligaments arising from the interpterygoid aponeuroses, coursing from the lateral pterygoid plate (LPP) to the undersurface of the sphenoid bone ( Fig. 1 ). The pterygoalar ligament of Hyrtl (innominate ligament, ligamentum crotaphitico-buccinatorium) is formed by the reinforced upper border of the lateral interpterygoid aponeurosis

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Amin B. Kassam, Paul Gardner, Carl Snyderman, Arlan Mintz and Ricardo Carrau

Object

The middle third of the clivus and the region around the petrous internal carotid artery (ICA) is a difficult area of the skull base in terms of access. This is a deep area rich with critical neurovascular structures, which is often host to typical skull base diseases. Expanded endoscopic endonasal approaches offer a potential option for accessing this difficult region. The objective of this paper was to establish the clinical feasibility of gaining access to the paraclival space in the region of the middle third of the clivus, to provide a practical modular and clinically applicable classification, and to describe the relevant critical surgical anatomy for each module.

Methods

The anatomical organization of the region around the petrous ICA, cavernous sinus, and middle clivus is presented, with approaches divided into zones. In an accompanying paper in this issue by Cavallo, et al., the anatomy of the pterygopalatine fossa is presented; this was observed through cadaveric dissection for which an expanded endonasal approach was used. In the current paper the authors translate the aforementioned anatomical study to provide a clinically applicable categorization of the endonasal approach to the region around the petrous ICA. A series of zones inferior and superior to the petrous ICA are described, with an illustrative case presented for each region.

Conclusions

The expanded endonasal approach is a feasible approach to the middle third of the clivus, petrous ICA, cavernous sinus, and medial infratemporal fossa in cases in which the lesion is located centrally, with neurovascular structures displaced laterally.