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Int J Environ Res Public Health 2022 May 25;19(11). Epub 2022 May 25.

Programma Neurochirurgia Ipofisi-Pituitary Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy.

Infratemporal and pterygopalatine fossae (ITF and PPF) represent two complex paramedian skull base areas, which can be defined as jewelry boxes, containing a large number of neurovascular and osteomuscular structures of primary importance. They are in close communication with many craniofacial areas, such as nasal/paranasal sinuses, orbit, middle cranial fossa, and oral cavities. Therefore, they can be involved by tumoral, infective or inflammatory lesions spreading from these spaces. Read More

World J Otorhinolaryngol Head Neck Surg 2022 Mar 22;8(1):42-53. Epub 2022 Mar 22.

Division of Rhinology and Skull Base Surgery, Department of Otolaryngology-Head & Neck Surgery Mayo Clinic Rochester Minnesota USA.

Objectives: To demonstrate three-hundred and sixty degrees of maxillary sinus (MS) surgical approaches using cadaveric dissections, highlighting the step-by-step anatomy of each procedure.

Methods: Two latex-injected cadaveric specimens were utilized to perform surgical dissections to demonstrate different approaches to the MS. The procedures were documented with macroscopic images and endoscopic pictures. Read More

Acta Neurochir (Wien) 2022 Jul 29;164(7):1911-1922. Epub 2022 Apr 29.

Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.

Purpose: This study defines the specific areas that connect the surgical corridors of the endoscopic endonasal (EEA) and transorbital approach (TOA) to identify adequate clinical applications and perspectives of this combined multiportal approach.

Methods: Consecutive patients who underwent combined EEA and TOA procedures for various pathologies involving multiple compartments of the skull base were enrolled.

Results: A total of eight patients (2 chondrosarcomas, 2 meningiomas, 2 schwannomas, 1 glioma, and 1 traumatic optic neuropathy) were included between August 2016 and April 2021. Read More

J Neurol Surg B Skull Base 2022 Apr 11;83(2):159-166. Epub 2021 May 11.

Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States.

 Temporalis muscle flap (TMF) is widely used in traditional skull base surgery, but its application in endoscopic skull base surgery remains rarely reported. We aimed to investigate the surgical anatomy and clinical application of TMF for reconstruction of skull base defects after expanded endoscopic nasopharyngectomy.  Nine fresh cadaver heads (18 sides) were used for endoscopic dissection at the University of Pittsburgh School of Medicine in the United States. Read More

Neurol Neurochir Pol 2022 18;56(2):178-186. Epub 2022 Mar 18.

Department of Neurosurgery, Università Politecnica delle Marche, Azienda Ospedali Riuniti, Ancona, Italy.

Aim Of The Study: Tumours of the infratemporal fossa (ITF) are rare and include primary tumours, contiguity lesions and metastases. Surgical resection is the gold standard. The fronto-orbito-zygomatic (FOZ) approach is commonly used in order to obtain safe access to the lateral skull base and ITF to resect intra- and extra-cranial tumours. Read More

Neurol India 2022 Jan-Feb;70(1):325-330

Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China.

Background: In skull base surgery, zygomaticectomy is an effective method to increase surgical exposure and reduce brain retraction. However, the traditional zygomaticectomy methods are complicated and more invasive.

Objective: To improve the procedure of zygomaticectomy, we introduced a modified technique to harvest integrated zygomatic arch-temporal bone flap. Read More

Iran J Otorhinolaryngol 2021 Nov;33(119):361-367

Department of Neurosurgery, Policlinico San Martino Hospital, IRCCS for Oncology and Neuroscience , Genoa, Italy.

Introduction: Transpterygoid approach is an expanded endonasal approach (EEA) that allows surgical access to the medial infratemporal fossa, to the skull base area of petrous bone and to the Meckel's cave. During this approach, a sacrifice of sphenopalatine artery is often required, leading to the need of contralateral Hadad-Bassagasteguy flap (HBF) or alternative reconstructive techniques.

Materials And Methods: We report a case of spontaneous CSF leak due to a meningo-encephalocele in the left lateral recess of sphenoid sinus, in which an ispilateral nasoseptal flap was harvest and sphenopalatine artery was preserved. Read More

BMJ Case Rep 2022 Feb 7;15(2). Epub 2022 Feb 7.

Department of Maxillo-Facial Surgery, University of Siena Faculty of Medicine and Surgery, Siena, Italy

Lipomas are benign tumours of mesenchymal origin, representing one of the most common tumours of the body. They are often observed between the fourth and the sixth decade of life and in 13% of the cases they occur in the head and neck region. In case of symptoms, surgical removal is the treatment of choice; when the formation involves the temporal region, the surgical approach is often challenging due to the presence of the neurovascular structures, such as the temporalis branch of the facial nerve and their potential extension to the nearby structures under the zygomatic arch to either the infratemporal fossa or the buccal region. Read More

Oper Neurosurg (Hagerstown) 2022 Jan;22(1):e44-e45

Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

Juvenile angiofibroma is a rare benign expansive lesion typically affecting young men. Surgery is the current mainstay of treatment. Because it is a very vascular lesion, preoperative transarterial embolization can decrease intraoperative bleeding. Read More

Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2022 Jan;36(1):68-72

The tumors occurring in infratemporal fossa （ITF） and parapharyngeal space account for 0.5%-1.0% of head and neck tumors, 80% of which are benign and 20% are malignant. Read More

World Neurosurg 2021 Nov 20;158:167. Epub 2021 Nov 20.

Department of Neurosurgery, Queen Elizabeth Hospital, Hong Kong.

Orbital apex lesions posed operative difficulties to neurosurgeons and ophthalmologists due to limited surgical corridor and close vicinity to cranial nerves and arteries. Lateral orbital apex lesions were traditionally operated via the transcranial route by neurosurgeons. Recently, only a handful of reports have described the use of endoscope alone for excision of lateral orbital apex lesion. Read More

J Neurol Surg B Skull Base 2021 Dec 5;82(6):668-674. Epub 2020 Oct 5.

Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, United States.

 Access to the infratemporal fossa (ITF) is complicated by its complex neurovascular relationships. In addition, copious bleeding from the pterygoid plexus adds to surgical challenge. This study aims to detail the anatomical relationships among the internal maxillary artery (IMA), pterygoid plexus, V and pterygoid muscles in ITF. Read More

Laryngoscope 2022 06 28;132(6):1275-1284. Epub 2021 Oct 28.

Department of Otology and Skull Base Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.

Objectives: To develop a novel grading system and appropriate surgical approaches for patients with diffuse type tensosynovial giant cell tumor (D-TGCT) of the temporal bone.

Study Design: Retrospective cohort study.

Methods: We retrospectively reviewed 31 patients with temporal bone D-TGCT between June 2012 and July 2021. Read More

Acta Neurochir (Wien) 2021 12 11;163(12):3439-3445. Epub 2021 Oct 11.

Department of Neurological Surgery, University of Colorado School of Medicine, 1635 Aurora Ct, 4th floor, Aurora, CO, 80045, USA.

Background: Approaching tumors involving the infratemporal fossa (ITF) is technically challenging due to the complex relationships between several neurovascular structures and the deep-seated location of these lesions.

Methods: The authors describe in detail a minimally invasive approach to the ITF, consisting on a single-nostril endoscopic endonasal transmaxillary approach aided by an anterior transmaxillary port (EEA-ATMa). Anatomical landmarks and surgical tenets of this approach are highlighted and reviewed with the goal to guarantee successful tumor resection and avoid operative complications. Read More

World Neurosurg 2022 Apr 2;160:e1-e8. Epub 2021 Sep 2.

Emory University School of Medicine, Department of Neurosurgery, Atlanta, Georgia, USA; Emory University Microsurgical Neuroanatomy and Skull Base Laboratory, Atlanta, Georgia, USA; Emory University School of Medicine, Department of Otolaryngology-Head & Neck Surgery, Atlanta, Georgia, USA. Electronic address:

Objective: To delineate the steps of exoscopic en bloc carotid artery-sparing total temporal bone resection for malignancies involving the temporal bone in a cadaveric model.

Methods: Dissections were performed on 3 right-sided (3 sides) formalin-fixed, latex-injected cadaveric specimens. An exoscopic en bloc carotid artery-sparing total temporal bone resection was performed on each cadaver. Read More

J Neurol Surg B Skull Base 2021 Jul 24;82(Suppl 3):e138-e147. Epub 2020 Jan 24.

Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States.

 The objective of this study is to describe the clinical presentation, tumor characteristics, natural history, and treatment patterns of sinonasal osteosarcoma.  Fourteen patients who had been treated for osteosarcoma of the nasal cavity and paranasal sinuses at a tertiary care center were reviewed. In addition, a systematic review of the literature for osteosarcoma of the sinonasal cavity was performed. Read More

Acta Otorhinolaryngol Ital 2021 Apr;41(Suppl. 1):S59-S66

Otolaryngology Unit, Department of Surgical, Medical, Molecular Pathology and Emergency Medicine, University Hospital of Pisa, Italy.

Laryngoscope 2021 12 29;131(12):2684-2687. Epub 2021 May 29.

Department of Otology and Skull Base Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.

J Neurol Surg B Skull Base 2021 Jun 6;82(3):357-364. Epub 2019 Nov 6.

Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Switzerland.

 This study was aimed to propose an expanded endoscopic-assisted lateral approach to the infratemporal fossa (ITF) and compare its area of exposure and surgical freedom with the endoscopic endonasal transptergyoid approach (EETA).  Anatomical dissections were performed in five cadaver heads (10 sides). The ITF was first examined through the endoscopically assisted lateral corridor, herein referred to as the endoscopic-assisted transtemporal fossa approach (TTFA). Read More

BMJ Case Rep 2021 May 21;14(5). Epub 2021 May 21.

Department of ENT and Head and Neck Surgery, Apollo Specialty Cancer Hospital, Chennai, Tamil Nadu, India.

The objective of this article is to elucidate on our experience with the first case reported in the literature of a synchronous presentation of pleomorphic adenoma (PA) in infratemporal fossa as well as the contralateral submandibular gland. PA most commonly arises from the major salivary glands but has also been reported to arise from minor salivary glands in unusual sites such as the nasal septum, main stem bronchus, trachea, lacrimal gland, external auditory canal, etc. However, it seldom involves the infratemporal fossa and extremely few cases are reported in the literature and coexistent contralateral synchronous PA is nowhere reported in literature. Read More

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2021 May;56(5):417-423

Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.

By summarizing the technical points and therapeutic outcomes of combing infratemporal fossa approach (IFA) and internal carotid artery (ICA) reconstruction for the colossal skull base tumor invading ICA in petrous bone, the clinical application value was discussed. Five patients (2 males, 3 females,aging from 27 to 55 years old) who received surgeries between July 2015 and May 2017 for lateral skull base pathology involved petrous ICA using technique combined IFA and pre-reconstruction, were reviewed. Among the five patients, three were paraganglioma of head and neck, one was carotid aneurysms, and one was recurrent adenoid cystic carcinoma (ACC). Read More

J Clin Neurosci 2021 Jun 3;88:251-258. Epub 2021 May 3.

Department of Neurosurgery, The First Affiliated Hospital (YiJiShan Hospital) of Wannan Medical College, No 2 Zheshan West Road, WuHu, China. Electronic address:

Background: Endoscopic endonasal approach to paramedian cranial base implies sacrifice of the nasal structures.

Objective: The present study aimed to illustrate the anatomy and provide critical anatomical landmarks for the endoscopic prelacrimal recess approach (PLRA) to the paramedian middle cranial base.

Methods: Anatomical dissections were performed in 10 cadaveric specimens. Read More

Oper Neurosurg (Hagerstown) 2021 07;21(2):E171-E172

Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.

Oper Neurosurg (Hagerstown) 2021 07;21(2):E169-E170

Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, Saint Louis, Missouri, USA.

Oper Neurosurg (Hagerstown) 2021 06;21(1):E15-E21

Department of Neurosurgery, Stanford Medical Center, Stanford, California, USA.

Background: Reconstruction after endoscopic endonasal approaches is a key element. Lower clivus reconstruction is difficult and most of the times a pedicled flap is not available. As the complexity and the dimensions of the exposure increase, a reliable reconstruction technique becomes more and more important. Read More

Oper Neurosurg (Hagerstown) 2021 07;21(2):E105-E106

Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

Chordoma is not a benign disease. It grows invasively, has a high rate of local recurrence, metastasizes, and seeds in the surgical field.1 Thus, chordoma should be treated aggressively with radical resection that includes the soft tissue mass and the involved surrounding bone that contains islands of chordoma. Read More

Acta Neurochir (Wien) 2021 08 29;163(8):2165-2175. Epub 2021 Apr 29.

Department of Neurosurgery, Lariboisière Hospital, University of Paris, 2 rue Ambroise Paré, 75010, Paris, France.

Objective: To demonstrate the utility and limitations of the extradural endoscopic-assisted anterior temporal fossa approach to the pterygopalatine fossa (PPF), infratemporal fossa (ITF), paranasal sinuses (PS), parapharyngeal region (PPR), nasal cavities (NC), epipharynx (EP), and clivus.

Methods: A frontotemporal orbitozygomatic craniotomy is performed. The dura is elevated from the cavernous sinus (CS). Read More

Oral Oncol 2021 08 26;119:105283. Epub 2021 Apr 26.

Head and Neck Oncology, Chris O'Brien Lifehouse, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia. Electronic address:

Head Neck 2021 06 25;43(6):1964-1970. Epub 2021 Mar 25.

Department of Otorhinolaryngology, Chinese University of Hong Kong, Hong Kong, China.

Robotic transmaxillary skull base surgery has been described using multiport systems. This cadaveric study investigates the feasibility of transmaxillary skull base surgery using a next-generation robot. An extended Caldwell-Luc antrostomy, measuring 3. Read More

J Vis Exp 2021 02 26(168). Epub 2021 Feb 26.

Department of Otolaryngology, Eye & ENT Hospital, Fudan University; Research Units of New Technologies of Endoscopic Surgery in Skull Base Tumor, Chinese Academy of Medical Sciences;

The technique of maxillectomy has been revised since it was first described in the 1820s. During the past decade, the endoscopic approach has been widely practiced for resecting maxilla. Compared with the traditional approaches, the combined endoscopic and transoral approach has many advantages such as avoiding facial incisions and postoperative scars and better visualization of the surgical margin. Read More