Vascular Control-Focused Surgical Strategy for Pterygopalatine and Infratemporal Fossa Tumors Using Multimodal Image Fusion Reconstruction.

OBJECTIVE: To classify tumor-internal maxillary artery (IMA) spatial relationships in pterygopalatine and infratemporal fossa (PPF/ITF) tumors, develop a 3D fusion-guided vascular control-focused surgical strategy, and evaluate its clinical impact. METHODS: Seventeen patients were prospectively enrolled in the 3D fusion-guided vascular control-focused strategy (VCFS) group, while 41 patients were retrospectively enrolled in the conventional strategy group. Multimodal imaging data were used to generate patient-specific 3D models to classify tumor-IMA spatial relationships and guide surgical planning under the VCFS framework. Surgical outcomes were compared using stabilized inverse probability of treatment weighting (sIPTW). RESULTS: Compared to the conventional strategy, the VCFS significantly reduced blood loss (200 vs. 800 mL; p = 0.037), decreased complications (33.8% vs. 74.3%; p = 0.017), improved complete resection rates (94.7% vs. 32.7%; p < 0.001), but prolonged operative time (4.5 h vs. 3.0 h; p = 0.005). Hospital stay was similar. CONCLUSIONS: Multimodal imaging-based classification of tumor-IMA relationships and application of the VCFS were associated with improved short-term surgical outcomes in patients with PPF/ITF tumors.