Anatomic-topographic substantiation of surgical approaches to tumors of the middle cranial fossa

Shimansky V.N., Makhmudov U.B.

(Burdenko Research Neurosurgical Institute, Moscow, Russia)

According to different authors, tumors of the middle cranial fossa account for 0.8-6% of all intracranial neoplasms. Benign tumors (meningiomas, neurinomas of the trigeminal nerve, chordomas) are the most frequent pathology among tumors of the skull base, including those with initial growth in its middle segments. They are watched in 75-80% of cases with neoplasms of the middle cranial fossa. Neurinomas of the facial nerve, epidermoid cysts, glomus tumors and malignant tumors of different origin are less frequent. There were 200 patients with the above pathology, treated in the Burdenko Research Neurosurgical Institute during the last 7.5 years (1993-2000); it accounted for 1.4% of all patients, admitted there. Results of the analysis of this material are presented.

Besides, the authors describe microsurgical anatomy of the middle cranial fossa from the point of view of surgical approaches. Examples of tumors with initial growth in the middle cranial fossa, illustrated by CT and MRI images and an angiographic picture, are given. Different modifications of a pterional approach, based on the above data, are proposed. Experience of their use during the last 7.5 years, as well as difficulties and complications, connected with them, are described.

Examples of correct choice of surgical approaches, their performing and removal of tumors (neurofibroblastoma and meningioma) of the middle cranial fossa are demonstrated in the form of a film (8 min).

Presentation of the second volume of "Clinical Manual on Craniocerebral Trauma", edited by Academician Konovalov A.N., Prof. Likhterman L.B., Prof. Potapov A.A. took place on May 31, 2001. (1000 copies; 85 printer's sheets; color and black-and-white illustrations; published by Antidor Moscow Publishing House).