Infratemporal Fossa Approaches to the Jugular Foramen

Abstract

The infratemporal fossa provides access to lesions of the lateral skull base, including the jugular foramen. Variants of the infratemporal fossa approaches are classified as types A, B, C, and D. The Fisch type A approach is most commonly used for glomus jugulare tumors that invade the infralabyrinthine and apical components of the temporal bone or tumors that extend intradurally. Lesions of the jugular foramen, including glomus tumors, meningiomas, and schwannomas, can be resected through this approach. The infratemporal fossa, a cavity with incomplete walls, contains the pterygoid venous plexus, the pterygoid muscles, the maxillary artery, and the mandibular division of the trigeminal nerve. Involvement of the internal carotid artery, combined with preoperative intolerance to balloon occlusion or significant intraoperative blood loss, may preclude complete resection of a glomus jugulare tumor. However, complete resection can be achieved in most cases. Injuries to the lower cranial nerves from tumor resection typically result in transient dysfunction but are expected to improve gradually.