Infra-temporal fossae tumors: Description of endoscopic endonasal surgery approach, surgical anatomy and report of illustrative cases

Abstract

The infratemporal fossa is a space located inferior and posterior to the maxilla (upper jawbone) and deep to the zygomatic arch (cheekbone). It is an anatomical region within the skull, specifically in the temporal bone area. The infratemporal fossa is bounded by various structures and contains important neurovascular structures. While the infratemporal fossa is traditionally approached through external approaches, such as lateral skull base surgery, there have been advancements in minimally invasive techniques that allow access to this region using an endoscopic endonasal approach. Infratemporal fossa tumors can occasionally be managed through endoscopic surgery, particularly when the tumor extends into the skull base or involves adjacent structures. However, the feasibility and appropriateness of this approach depend on the specific characteristics of the tumor and the expertise of the surgical team. The selection of patients for endoscopic endonasal surgery depends on various factors, including tumor characteristics (size, location, extent), patient anatomy, and the expertise of the surgical team. Tumors located in the medial and posterior infratemporal fossa is more suitable for endoscopic endonasal surgery. These techniques are often used for benign tumors, such as schwannomas, or selected cases of malignancies, where the tumor's size and extension are favorable for this approach. Endoscopic endonasal surgery involves accessing the infratemporal fossa through the nasal passages and creating a corridor to reach the tumor using visualization and specialized instruments to remove the tumor while preserving surrounding structures and minimizing trauma. This approach requires a multidisciplinary team, including neurosurgeons and radiologists. Collaboration among these specialists is crucial for preoperative planning, intraoperative decision-making, and postoperative care. It's important to note that endoscopic endonasal surgery for infratemporal fossa tumors is a specialized technique performed by experienced surgical teams. The selection of the surgical approach depends on various factors, and not all cases are suitable for this minimally invasive approach. Each patient's situation should be evaluated on an individual basis, considering factors such as tumor characteristics, surgical expertise, and patient anatomy.