Right Preauricular Transcranial Infratemporal Fossa Transcavernous Approach to a Cavernous Sinus/Meckel Cave Meningioma with Infratemporal Fossa Extension: 2-Dimensional Operative Video

Abstract

Tumors involving the infratemporal fossa can arise directly fromthe infratemporal fossa or can extend fromnearby regions. Early approaches described to access these lesions were invasive, cosmetically disfiguring with high rates of morbidity.1,2 This led to the development of less invasive approaches.3-8 Surgery for lesions in this region is challenging due to the anatomic complexity and the neurosurgeon's general unfamiliarity with this region. We present a 33-year-old woman with progressive right V2/V3 hypoesthesia for 10 months.Workup revealed a cavernous sinus/Meckel cave lesionwith extension into the infratemporal fossa. Needle biopsy performed at an outside institution confirmed meningioma World Health Organization grade 1. She subsequently presented to us for treatment. In view of her young age and aggressive radiological features of the tumor,we elected a right preauricular transcranial infratemporal fossa transcavernous approach. The patient was discharged on POD2 at her neurological baseline but returned on POD3 with intractable headaches and a small venous infarct of the inferior temporal lobe with hemorrhagic transformation. The patient was managed conservatively with steroids and observation and recovered fully. At follow-up, she continued to have right V2/V3 hypoesthesia and some temporalis atrophy. Postoperative imaging revealed 98% resection with expected small residual in the cavernous sinus adherent to V1. The case presentation, surgical anatomy, and operative technique are reviewed. We demonstrate step-bystep surgical technique of an anterior infratemporal fossa combined transcavernous approach, tumor resection, and review various surgical approaches to the infratemporal fossa. The patient consented to the procedure and to the publication of his/her image. Illustrations at 1:36 reprinted from Tayebi Meybodi et al,8