Dr.Rayappa.com

Approaches to Skull Base

I Anterior Cranial Base

Anterior craniofacial resection
Basal subfrontal approach

II Middle Cranial Base

Central Compartment

Trans septal sphenoid
Transpalatal
Extended maxillotomy
Midfacial split

Lateral Compartment

Infratemporal fossa approach l case 1 l case 2
Transparotid
Subtemporal preauricular infratemporal fossa approach
Trans facial approaches

Facial translocation approach l case 1 l case 2
Extended osteoplastic maxillotomy approach
Extended transfacial subcranial approach l case 1 l case 2

III Posterior cranial base

Transtemporal approaches

Translabyrinthine approach
Transotic approach
Transcochlear approach l Case 1 l Case 2

Extreme lateral/transcondylar approach

Skull Base Surgery

Extended Osteoplastic Medial Maxillotomy Approach

Case-1

A 42 year old male had left extraocular palsy due to a large parapharyngeal mass extending into the cavernous sinus and was diagnosed as a low grade sarcoma. After initial chemotherapy, the patient regained ocular movements and there was reduction in tumour size. The residual tumour was resected through an extended osteoplastic medial maxillotomy approach. Nine months after surgery he developed a small recurrence in the upper neck for which he was given chemotherapy.


MRI after chemotherapy shows the tumour in the left parapharyngeal space from the skull base to the level of tip of epiglottis.MRI after chemotherapy shows the tumour in the left parapharyngeal space from the skull base to the level of tip of epiglottis.		A-Temporal craniotomy; B-Temporal lobe; C-V nerve; D-Temporalis muscle; E-Tumour; F-Soft palate; & G-Mobilized osteoplastic unit. Posterior antral wall and pterygoids are removed.

Peroperative photograph shows the wide exposure of nasopharynx and infratemporal fossa.		Osteoplastic unit is repositioned and plated.

Good occlusion after plating the osteoplastic unit.		Postoperative photograph.

Postoperative CT shows the operated site filled in by the temporalis muscle.		Postoperative CT shows the operated site filled in by the temporalis muscle.