Skull Base Lesions Extending Towards Multiple Compartments: The Role of Maxillary Swing Approach in the Endoscopic Era

Abstract

Objective: Although advances in endoscopic techniques, resection of complex lesions that occupying multiple compartments in the skull base still represents significant challenges, since surgical outcomes may be compromised by insufficient exposure and inappropriate techniques. The question of whether to perform endoscopic surgery or to use open craniofacial approach remains unresolved. Nevertheless, careful assessment of lesion characteristics must be carried out in selection of the appropriate trajectory.
Methods: Between May 2006 and November 2016, 16 patients experienced resection of extensive lesions in the skull base via maxillary swing approach. Data regarding clinical findings and technical considerations as shown in case illustrations were discussed.
Results: Complete resection was achieved in all patients. Pathological findings were diverse, while the majority were schwannomas (10 cases, 62.5%) followed by meningiomas (3 cases, 18.75%). The complications were managed as shown in case illustrations, and symptoms improved with time. The follow-up duration ranged from 49 to 177 months (median, 102 months), while 2 patients were lost. There was no postoperative mortality, and 1 patient who experienced a relapse of meningioma 72 months after surgery is still under observation due to asymptomatic status.
Conclusions: Our preliminary results suggest that the maxillary swing approach can be an alternative option in management of extensive, recurrent, and hypervascularized masses with fibrous or calcified consistency in the skull base, which may represent challenges for the endoscopic procedure. Future studies are required to demonstrate the surgical indications and efficiency.