61590 Infratemporal pre-auricular approach to middle cranial fossa (parapharyngeal space, infratemporal and midline skull base, nasopharynx), with or without disarticulation of the mandible, including parotidectomy, craniotomy, decompression and/or mobilization

Name of the Procedure:

Infratemporal Pre-auricular Approach to Middle Cranial Fossa

Summary

The infratemporal pre-auricular approach to the middle cranial fossa is a surgical procedure used to access the skull base structures located deep within the head. It addresses complex conditions near the parapharyngeal space, infratemporal, and midline skull base, and nasopharynx. The surgery may involve disarticulating the mandible and includes procedures such as a parotidectomy and craniotomy for decompression or mobilization of tissues.

Purpose

• Medical Condition/Problem: Tumors, lesions, or other abnormalities in the parapharyngeal space, infratemporal fossa, midline skull base, and nasopharynx.
• Goals/Outcomes: To remove or treat abnormalities, relieve pressure on cranial nerves, improve neurological function, and prevent further complications.

Indications

• Tumors or growths in the infratemporal fossa or near the middle cranial fossa
• Chronic infections of the parapharyngeal space
• Persistent neurological symptoms related to skull base issues
• Certain cases of skull base fractures

Preparation

• Pre-procedure Instructions: Fasting for at least 8 hours prior to the procedure. Adjustments or discontinuation of certain medications as directed by the healthcare provider.
• Diagnostic Tests: Imaging studies such as MRI or CT scans, blood tests, and a thorough pre-surgical evaluation by an anesthesiologist.

Procedure Description

1. Anesthesia: The patient is placed under general anesthesia.
2. Incision: An incision is made in front of the ear to access the infratemporal region.
3. Exposure: The parotid gland is typically mobilized or removed (parotidectomy) to enable better access.
4. Mandible Management: If necessary, the mandible may be disarticulated to provide a clear view and access to the skull base.
5. Craniotomy: Part of the skull (craniotomy) is removed to expose the brain and underlying structures.
6. Decompression/Mobilization: Decompression or mobilization of tissues is performed to address the patient’s condition.
7. Closure: All tissues are repositioned, and the incision is closed with sutures.

Duration

The procedure typically takes 4 to 8 hours, depending on the complexity.

Setting

The surgery is performed in a hospital surgical suite.

Personnel

• Lead Surgeon (Neurosurgeon or Skull Base Surgeon)
• Assistant Surgeons
• Anesthesiologist
• Surgical Nurses
• Operating Room Technicians

Risks and Complications

• Common Risks: Infection, bleeding, facial nerve injury, swelling
• Rare Risks: Cerebrospinal fluid leak, hearing loss, persistent neurological deficits
• Management: Close monitoring, antibiotics, specialized care for nerve injury

Benefits

• Removal or treatment of abnormal growths
• Relief from symptoms caused by pressure on nerves or structures
• Potential improvement in neurological function
• Long-term control or cure of the underlying condition

Recovery

• Post-procedure Care: Pain management, antibiotics, and anti-inflammatory medications as needed.
• Recovery Time: Hospital stay for several days followed by weeks to months of recovery at home. Specific restrictions on physical activities.
• Follow-up: Regular appointments with the surgeon and possibly imaging studies to monitor recovery.

Alternatives

• Radiation Therapy: Non-invasive but may not be as effective for large or complex tumors.
• Chemotherapy: For certain types of tumors but not typically effective for structural abnormalities.
• Less Invasive Surgical Approaches: Might be considered depending on the location and size of the pathology.
• Pros and Cons: Each alternative carries its own sets of risks and benefits, often with lower immediate surgical risks but potentially less definitive outcomes.

Patient Experience

• During the Procedure: The patient will be under general anesthesia and will not feel anything.
• After the Procedure: The experience may include pain, swelling, and temporary facial weakness. Pain management strategies will be employed to keep discomfort minimal.
• Long-term: Gradual improvement with physical therapy and follow-up care contributing to recovery and return of function.