[A new operative mode for sphenoclival regions; trans Le Fort I approach]

Tumors in the sphenoclival region have conventionally been approached transseptally (transsphenoidally) or transorally; however, the following disadvantages have not allowed wide application of these approaches; 1) limited operative field, especially at the lateral side, 2) unsatisfactory repair for the dural defects. We have applied Le Fort I osteotomy for lesions in this region, and we called the operative technique, by which we approached via the space that was obtained by moving the osteomized maxillary bone to the mandibular bone, trans Le Fort I approach. We have applied this approach in 5 patients and obtained a substantially wider operative field than that obtained by the conventional approach, with successful results. Three out of 5 patients were operated on via this trans Le Fort I approach, and the other 2 via this approach combined with mandibular midsplitting, which was performed to make a median osteotomy of the mandibular bone to accommodate osteomized maxillary bone (this technique is referred to as trans Le Fort I with mandibular midsplitting). The tumor was totally resected in 4 cases, and subtotally in 1 case with wide dural incision. One case was temporarily complicated with diabetes insipidus after the operation, but there were no complications in the remaining cases. Prognoses in patients were good in 2, fair in 1, and poor in 2 due to tumor progression. Although tracheostomy is inevitable with this approach, we think this technique is beneficial in operations of the skull base because, compared with conventional techniques, a somewhat wider operative field can be expected with this technique.