Abstract
The middle cranial base is a difficult area in which to gain wide surgical access because of anatomical complexity. We presented two cases with middle cranial base tumors.
The first case presented with a neurinoma originated from the parapharyngeal space which extended into the middle cranial cavity through the oval foramen. The operation was performed with the combined intracranial and extracranial approaches. In the extracranial part, the anterolateral transfacial approach was employed. The zygoma was reflected with preservation of the attachment of the masseter. After the resection of the tumor, the zygoma was replaced using miniplates. The postoperative facial deformity was acceptable for the patient.
The second case presented with a chordoma which originated from the clivus and extended to the nasopharynx and nasal cavity. However, the tumor did not invade into the intracranial cavity. The operation was performed under the anterior transfacial approach. After the osteotomy of the maxilla and palate, this bone complex was reflected to the lateral direction with the preservation of its vascularity. The tumor was widely exposed and subtotally extirpated. Finally, the transsected bone complex was replaced and the facial contour was satisfactorily preserved.
Many different approaches to the middle cranial base have been advocated. We classified these approaches into three groups. The first one is the anterior approach and this is also subdivided into the transantral, transoral and transmandibular approaches. The second one is the anterolateral (transzygomatic) approach. The final one is the lateral approach which includes the infratemporal fossa and transcervical approaches. From our clinical experience and a study of the cadaver dissection, it was confirmed that a wide surgical access to the middle cranial base can be obtained by the anterolateral and infratemporal fossa approaches. However, the approach should be selected by a size, direction of the extension and a histological diagnosis of the tumor.
