Neurocirugía Neurocirugía
Neurocirugia.1999;10:210-8 - Vol. 10 Núm.3 DOI: 10.1016/S1130-1473(99)70798-0
Abordaje infratemporal preauricular a los tumores de la base del cráneo: Nuestra experiencia clínica
Infratemporal preauricular approach to skull base tumors
A. Romance, G. Sánchez Aniceto, R. Gutiérrez, R.D. Lobato, R. Alday, A. De La Lama, R. de la Mata
Servicios de Cirugía Maxilofacial y Neurocirugía. Hospital Doce de Octubre. Madrid
Resumen
Objetivos

Revisión del abordaje infratemporal preuricular, empleado en la resección de tumores de la base del cráneo por los Servicios de Cirugía Maxilofacial y Neurocirugía del Hospital Doce de Octubre. Madrid.

Material y Métodos

Estudio retrospectivo de once casos de tumores de la región infratemporal de la base craneal. Ocho de los mismos con afectación intracraneal. Tres eran tumores histológicamente malignos. En dos pacientes este abordaje se combinó con la técnica de la translocación facial ampliada.

Resultados

Las resecciones fueron completas en nueve enfermos, persistiendo en dos casos restos tumorales a nivel del seno cavernoso. Un solo paciente murió por recidiva local del tumor. Las complicaciones postquirúrgicas se relacionaron con resecciones amplias que afectaban piel, senos paranasales o con la combinación de otros abordajes. Ningún paciente presentó parálisis facial o disfunción de la articulación temporomandibular.

Conclusiones

El abordaje quirúrgico de los tumores de la base del cráneo depende fundamentalmente de la localización de la lesión. El abordaje infratemporal preauricular es, en nuestra experiencia, el de elección para la resección de los tumores de la fosa infratemporal. Este abordaje permite resecar con facilidad y seguridad los tumores de esta localización y sus extensiones a la región retro-parafaríngea, nasofaríngea, senos paranasales, región petroclival, pared lateral del seno cavernoso y órbita. Cuando el tumor infiltra las regiones parasellares, fosa nasal y orofaringe, se combina con la técnica de la translocación facial ampliada, consiguiéndose un único campo quirúrgico con distintas vías de disección del tumor.

Summary
Objetive

To present our results with the preauricular- infratemporal fossa approach to neoplasm involving the craneal base.

Methods

Retrospective review of eleven cases of infratemporal tumor involving the cranial base. Eight patients had intracranial involvement. Three tumors were malignant. A preauricular-infratemporal fossa approach was combined with extended facial translocation in two patients.

Results

Total tumor removal was performed in nine patients and subtotal excision was achieved in two with cavernous sinus involvement. One patient died after local recurrence. Patients, who underwent extended resections to skin and paranasal sinus, had more postoperative complications. None patient developed facial palsy or temporal joint disfunction.

Conclusions

Surgical approach for skull base tumors should be selected according to the tumor location. Tumors confined to the infratemporal fossa are better removed by preauricular-infratemporal fossa approach. Infratemporal tumors, extended to the parapharyngeal and retropharyngeal areas, the nasopharynx, petroclival region, and the lateral aspect of the cavernous sinus and orbit, were excised safely with this approach. A preauricular-infratemporal fossa approach may be combined with expanded facial translocation providing an excellent surgical field with a complete vision of tumor.

Key words
Skull base neoplasm, Lateral approach, Infratemporal tumors, Craniofacial resection
Palabras clave
Tumores de la base del cráneo, Abordaje lateral, Tumores infratemporales, Resección craneofacial
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Romance, A.; Sánchez Aniceto, G.; Gutiérrez, R.; Lobato, R.D.; Alday, R.; De la Lama, A.; De la Mata, R.: Abordaje infratemporal preauricular a los tumores de la base del cráneo: nuestra experiencia clínica. Neurocirugía 1999; 10: 210–218.

Copyright © 1999. Sociedad Española de Neurocirugía
Neurocirugia.1999;10:210-8 - Vol. 10 Núm.3 DOI: 10.1016/S1130-1473(99)70798-0