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The mandibular swing-transcervical approach to the skull base: anatomical study. Technical note
M Ammirati1, J Ma, M L Cheatham
1Division of Neurosurgery, University of California, Los Angeles.
Journal of Neurosurgery
|April 1, 1993
Summary
This study details a surgical approach for extensive skull base lesions, enhancing access to midline and lateral compartments via a combined oral and cervical route. It ensures full neurovascular control for complex tumor removal.
Area of Science:
- Neurosurgery
- Surgical Anatomy
- Skull Base Surgery
Background:
- Extensive skull base lesions pose significant surgical challenges.
- Access to midline and lateral skull base compartments requires specialized techniques.
- Previous approaches have limitations in achieving adequate exposure and control.
Purpose of the Study:
- To describe a stepwise surgical anatomy for an extended approach to the skull base.
- To detail a technique involving mandibulotomy and pharyngeal detachment.
- To highlight neurovascular control and exposure capabilities for skull base tumors.
Main Methods:
- A combined oral and cervical approach was utilized.
- Mandibulotomy and detachment of the pharynx from the skull base were key steps.
- The procedure focused on achieving neurovascular control of the internal carotid artery and cranial nerves.
Main Results:
- The approach provides access to midline and lateral skull base compartments (clivus, infralabyrinthine/infratemporal regions).
- Full neurovascular control of the internal carotid artery and lower cranial nerves is achieved.
- Complete exposure of the intrapetrous and intracavernous segments of the internal carotid artery is possible.
Conclusions:
- This expanded surgical approach is valuable for managing extensive skull base lesions.
- The technique offers enhanced exposure and control for complex skull base pathologies.
- It represents an advancement in skull base surgery, building upon prior work.