Excision by Lateral Skull Base Approach

Abstract

The lateral approach is a preauricular, subcranial technique that traverses the infratemporal fossa (ITF) for surgical resection of juvenile angiofibroma (JA). Although these lesions originate medially relative to the ITF within the nasal cavity, it is not necessary to visualize the point of origin directly to achieve safe removal with this technique. Thus, the angle of approach for removal can be superior, medial, and smaller than a more extensive classically described posterior infratemporal fossa approach that compromises the overall structure of the middle ear. The lateral approach is ideal for JAs that extend lateral to the foramen rotundum and abut the cavernous sinus. The effectiveness of this technique relies on both successful preoperative endovascular embolization and the fibrous nature of the tumor. These fibrous characteristics allow initial mobilization and subsequent extraction by lateral traction of the tumor from its medial point of origin, obviating the need to further compromise sinonasal structures associated with other approaches. This chapter presents the lateral approach features, indications, patient selection considerations, techniques, modifications, and potential complications with illustrative figures.