A New Operative Mode for Sphenoclival Regions; Trans Le Fort I approach Katsuhiro KAWAKAMI 1 , Yasuo YAMANOUCHI 1 , Kohichi MATSUMOTO 1 , Nobuyuki SAKAI 1 , Yasuo KAWAMURA 1 , Hiroshi MATSUMURA 1 , Sadao TAJIMA 2 1Department of Neurosurgery, Kansai Medical University 2Department of Plastic Surgery, Osaka Medical College Keyword: Le Fort I osteotomy , Skull base tumor , Sphenoclival region , Anterior ap-proach , Craniofacial resection pp.333-338
Published Date 1992/4/10
DOI https://doi.org/10.11477/mf.1436900427
  • Abstract
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Tumors in the sphenoclival region have conventional-ly been approached transseptally (transsphenoidally) or transorally ; however, the following disadvantages have not allowed wide application of these approaches ; 1) limited operative field, especially at the lateral side, 2) unsatisfactory repair for the dural defects. We have ap-plied Le Fort I osteotomy for lesions in this region, and we called the operative technique, by which we approached via the space that was obtained by moving the osteomized maxillary bone to the mandibular hone, trans Le Fort I approach. We have applied this approach in 5 patients and obtained a substantially wider operative field than that obtained by the conven-tional approach, with successful results. Three out of 5 patients were operated on via this trans Le Fort I approach, and the other 2 via this approach combined with mandibular midsplitting, which was performed to make a median osteotomy of the mandibular bone to accommodate osteomized maxillary bone (this techni-que is referred to as trans Le Fort I with mandibular midsplitting). The tumor was totally resected in 4 cases, and subtotally in 1 case with wide dural incision. One case was temporarily complicated with diabetes in-sipidus after the operation, but there were no complica-tions in the remaining cases. Prognoses in patients were good in 2, fair in 1, and poor in 2 clue to tumor progres-sion.

Although tracheostomy is inevitable with this approach, we think this technique is beneficial in opera-tions of the skull base because, compared with conven-tional techniques, a somewhat wider operative field can be expected with this technique.

Copyright © 1992, Igaku-Shoin Ltd. All rights reserved.


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