Infratemporal fossa surgery for malignant diseases

Area of Science:

• Neurosurgery
• Surgical Oncology
• Anatomy

Background:

• Advances in anatomical understanding of the infratemporal fossa are crucial for surgical safety.
• Improved knowledge leads to conceptual evolution in geometrical anatomico-surgical characteristics.
• This evolution offers significant surgical and oncological advantages, including better resection margin control and en-bloc dissection.

Purpose of the Study:

• To highlight the surgical and oncological benefits derived from enhanced anatomical knowledge of the infratemporal fossa.
• To detail how improved understanding of anatomical landmarks refines surgical approaches and outcomes.
• To correlate specific surgical techniques with tumor location and extent within the infratemporal fossa and surrounding structures.

Main Methods:

• Review and synthesis of anatomical knowledge related to the infratemporal fossa.
• Description of various surgical approaches based on tumor characteristics and location.
• Emphasis on the lateral approach for wider exposure, shorter working depth, and vascular control.

Main Results:

• The lateral approach to the infratemporal fossa provides enhanced surgical field exposure and microsurgical capabilities.
• Specific transfacial and transcraniofacial approaches are indicated based on tumor location (inferior vs. superior compartments).
• Intradural and combined antero-lateral approaches are necessary for extensive skull base invasion or secondary spread from the maxilla.

Conclusions:

• Enhanced anatomical knowledge directly improves the safety and efficacy of surgical treatments for infratemporal fossa pathologies.
• A precise understanding of anatomical limits and tumor biology dictates the choice of surgical approach for optimal oncological clearance.
• The study underscores the importance of tailored surgical strategies, including lateral transfacial and transcraniofacial techniques, for managing complex infratemporal fossa neoplasms.