Abstract
Lesions located in the middle fossa, prepontine and interpeduncular cisterns are some of the most difficult to approach in case of radical surgery, even with the aid of an operating microscope. To minimize the retraction of the temporal lobe and achieve wide exposure, many operative modalities have been reported.
We describe a zygomatic approach without removal of the lateral orbital rim, which we developed based on a modification of Fujitsu's approach. This approach has been used in 8 patients: 2 with aneurysms in the territory of the basilar artery, 3 with brain stem ischemia, 1 with a hypothalamic hematoma, and 1 with a cavernous angioma in the midbrain. The last patient had an anterior communicating artery aneurysm and a concomitant temporal convexity meningioma.
Complete clip ligation was performed for all 3 aneurysms and gross total removal was achieved in hypothalamic hematoma case and cavernous angioma case. Also, the anastomosis of the superficial temporal artery to superior cerebellar artery was performed for 3 patients with brain stem ischemia. One patient with a large basilar tip aneurysm died due to initial damage of the brain on attack. Another with cavernous angioma developed left hemiparesis and oculomotor palsy but these symptoms markedly improved 6 months after the operation.
The complications we observed in this series, consisted of 2 types. The first comprised temporary third nerve paresis in 2 cases and the second was temporal muscle atrophy. Based on our experience and the operative results obtained, we concluded that this procedure allows a wide operative field and easy access to the interpeduncular fossa with minimal brain retraction.
