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Petrosal approach mastoidectomy

Daniele Marchioni, Davide Soloperto, Alessia Rubini, João Flávio Nogueira, Mohamed Badr-El-Dine, Livio Presutti
Tympanic facial nerve segment surgery has been traditionally performed using microscopic approaches, but currently, exclusive endoscopic approaches have been performed for traumatic, neoplastic, or inflammatory diseases, specially located at the geniculate ganglion, greater petrosal nerve, and second tract of the facial nerve, until the second genu. The tympanic segment of the facial nerve can be reached and visualized using an exclusive transcanal endoscopic approach, even in poorly accessible regions such as the second genu and geniculate ganglion, avoiding mastoidectomy, bony demolition, and meningeal or cerebral lobe tractions, with low complication rates using a minimally invasive surgical route...
October 2016: Otolaryngologic Clinics of North America
Shao-Ching Chen, Mao-Che Wang, Wei-Hsin Wang, Cheng-Chia Lee, Tsui-Fen Yang, Chun-Fu Lin, Jui-To Wang, Chih-Hsiang Liao, Chih-Chang Chang, Min-Hsiung Chen, Yang-Hsin Shih, Sanford P C Hsu
OBJECTIVE: Mastoidectomy can be risky due to the chance of iatrogenic facial nerve dysfunction. Avoiding injuries to the mastoid segment of the facial nerve is mandatory when drilling the bone. With advancements in intraoperative near-infrared indocyanine green (ICG) video angiography, we describe the application of a novel fluorescent guidance technique during mastoidectomies to identify the facial canal with safety. METHODS: Mastoidectomies were performed as the key step in the presigmoid, petrosal or translabyrinthine approaches in 16 patients with different pathologies located at the cerebellopontine angle or petroclival region...
April 2015: Auris, Nasus, Larynx
Katsuyuki Asaoka, Shunsuke Terasaka
The authors demonstrate a step-by-step surgical technique of the combined petrosal approach for resection of petroclival meningioma. The basic concept of this approach is the combination of the anterior- and posterior-petrosal approaches uniting the infra- and supratentorial surgical fields, thereby providing wide surgical exposure. Our techniques are featured by 1) mastoidectomy preceding craniotomy for minimal bone loss; 2) removal of the tentorium over the tumor for achieving devascularization and wide exposure; 3) water-tight dural closure by using autologous fascia graft, non-penetrating titanium clips, and multi-layered technique for avoiding postoperative cerebrospinal fluid leakage...
January 2014: Neurosurgical Focus
P Ladziński, M Maliszewski, W Kaspera, K Majchrzak, M Tymowski, B Błaszczyk
The aim of the study was to present consecutive stages of the posterior petrosal approach (PPA). Eighteen simulations of PPA were performed on non-fixed human cadavers without any known pathologies in the head and neck. The consecutive stages of the procedure were documented with photographs and schemes. The starting point for PPA is a temporal craniotomy, suboccipital craniectomy and mastoidectomy with keeping the bony labyrinth intact. Approach to the middle part of the clivus is achieved by raise of the temporal lobe and section of the superior petrosal sinus and tentorium and by mobilization the sigmoid sinus...
July 2013: Neurologia i Neurochirurgia Polska
David R Friedmann, Misha Amoils, John A Germiller, Lawrence R Lustig, Christine M Glastonbury, Bidyut K Pramanik, Anil K Lalwani
OBJECTIVES/HYPOTHESIS: CHARGE (Coloboma of the eye, Heart defects, Atresia of the choanae, Retardation of growth and/or development, Genital and/or urinary abnormalities, and Ear abnormalities and/or deafness) syndrome is a genetic disorder with prominent otolaryngologic features including choanal atresia and inner ear malformations. Recent experience with venous malformations during cochlear implant surgery prompted this study to define the spectrum of venous abnormalities in CHARGE and their surgical implications in otology...
April 2012: Laryngoscope
N Hayashi, M Kurimoto, S Nagai, H Sato, S Hori, S Endo
OBJECTIVE: The subtemporal transtentorial approach provides excellent exposure of the middle incisural space. A modification of the subtemporal transtentorial approach with use of a partial mastoidectomy is presented to avoid damage to the temporal lobe as a result of retraction as well as damage to venous structures. METHODS: Four patients, one with a superior cerebellar artery aneurysm, one with a metastatic tumor in the midbrain, one with a tentorial meningioma, and one with a tentorial schwannoma were treated with the present approach...
December 2008: Minimally Invasive Neurosurgery: MIN
Eric H Sincoff, Sean O McMenomey, Johnny B Delashaw
OBJECTIVE: We describe our surgical posterior transpetrosal technique, particularly the transcrusal variant for lesions involving the upper and middle clivus, petroclival regions, and lesions that involve both the posterior and middle fossae. METHODS: An outline of the posterior transpetrosal technique involved, particularly the transcrusal variant, is described. Important superficial landmarks are identified, and a radical mastoidectomy is performed. The antrum is identified and entered, and, upon completion of the mastoidectomy and when Trautman's triangle is defined, the temporal and suboccipital craniotomies are completed...
February 2007: Neurosurgery
Kazimierz Niemczyk, Andrzej Marchel, Antoni Bruzgielewicz, Olimpia Stanisławek
The authors describe various methods of surgical treatment of extensive petrous pyramid cholesteatoma. The surgical technics were selected to each individual patient. The approach depended on the disease's course, the lesion extention and the ear functional state. Total removing of cholesteatoma were possible by the lateral petrosectomy or by the middle fossa approach. The authors underline that petrous cholesteatoma can develop after previous radical mastoidectomy. The origin of this type of cholesteatoma is usually supratubal recess...
2004: Otolaryngologia Polska. the Polish Otolaryngology
H Wu, S M Zhou, Z J Li, S Q Zhang
OBJECTIVE: To investigate the surgical methods and results of enlarged translabyrinthine approach in the removal of large acoustic neuromas. METHOD: A large mastoidectomy involved complete exposure of sigmoid sinus, the dura behind the sinus for at least 1 cm, the superior petrosal sinus and the middle fossa dura. The jugular bulb was exposed and pressed downwards if necessary. The internal auditory meatus was skeletonized and uncovered for at least 270 degrees...
October 2000: Lin Chuang Er Bi Yan Hou Ke za Zhi, Journal of Clinical Otorhinolaryngology
Amitabha Chanda, Anil Nanda
OBJECTIVE: The petroclival region generally is thought to be an inaccessible area in the intracranial compartment. A number of ways of reaching this area during surgery have been described, including the presigmoid petrosal approach. The partial labyrinthectomy petrous apicectomy approach is a relatively new approach to this region and is a variant of the presigmoid petrosal approach. This study aims to demonstrate the technique and the microsurgical anatomy of the partial labyrinthectomy petrous apicectomy approach and to provide a quantitative study of its exposure to compare it with other common approaches to this region, particularly the presigmoid petrosal approach...
July 2002: Neurosurgery
J L Stone
Sir Charles A. Ballance (1856-1936) began his medical career at St. Thomas's Hospital the University College, London, England, in 1875, receiving honors in every subject and a gold medal in surgery. Victor Horsley (1857-1916) and Ballance were classmates at the University and in the later 1880s began work together at the Brown Institute and the National Hospital, Queen Square. In addition to important studies on vascular surgery, Ballance was involved in primate work on cerebral localization with lifelong friends Charles Beevor, Charles Sherrington, David Ferrier, and others...
March 1999: Neurosurgery
T Kinjo, J Mukawa, N Tomiyama
The petrosal approach has become a routine procedure for petroclival lesions, but there are some disadvantages such as the time-consuming craniotomy during surgery and depressed deformity of the mastoid area after surgery. To solve these disadvantages, we modified the petrosal approach. Before surgery, the three-dimensional points of the sigmoid sinus and semicircular canals are calculated on computed tomography scan and are input to a computer. A single temporooccipital bone flap is made, and the outer table of bone overlying the mastoid is preserved by forming a narrow groove with a small air drill and cutting the outer table with a chisel...
May 1996: Neurologia Medico-chirurgica
S A Ayeni, K Ohata, K Tanaka, A Hakuba
The microsurgical anatomy of the jugular foramen was studied in 10 fixed cadavers, each cadaver consisting of the whole head and neck. Five of the cadavers were injected with latex. The jugular foraminal region was exposed using the infratemporal fossa type A approach of Fisch and Pillsbury in five cadavers (10 sides) and the combined cervical dissection-mastoidectomy-suboccipital craniectomy approach in five cadavers (10 sides). The right foramen was larger than the left in seven cases (70%), equal in two cases (20%), and smaller in one case (10%)...
November 1995: Journal of Neurosurgery
J Kanzaki, R Shiobara, S Toya
In our approach for acoustic tumors, the method of Morrison and King and that of Bochenek and Kukwa have been modified into one method. This modified method is basically a neuro-otological-neurosurgical team approach, extending the operative field by drilling the temporal bone and cutting the superior petrosal sinus, tentorium, and posterior fossa dura according to the size of the tumor. Therefore, for tumors slightly protruding into the posterior fossa from the prous of the internal auditory canal, only the bone adjacent to it is removed (Bochenek et al's method)...
1980: Archives of Oto-rhino-laryngology
W W Montgomery
Surgery for resection of acoustic neurinomas (vestibular schwannomas) has been performed by way of the middle fossa craniotomy, suboccipital route, and translabyrinthine operation. The author has preferred the translabyrinthine operation for small tumors (less than 2 cm) for patients with poor hearing and the suboccipital approach for large tumors and for small tumors when attempting to preserve hearing. This paper proposes an operation designed for better tumor removal results, an improved technique for preservation of hearing, and fewer complications...
July 1984: Annals of Otology, Rhinology & Laryngology. Supplement
A Hakuba
The basic anatomy of the jugular foramen, some diagnostic principles of the jugular foramen tumors with presentation of our experiences of the 13 cases (6 neurinomas, 6 chemodectomas and 1 meningioma), and the detailed surgical technique used in their removal and its result are described. According to the extension of the tumor, one of the following operative approaches can be selected. A) Transjugular approach consists of a retromastoideal craniectomy following a radical mastoidectomy. The posterior wall of the jugular foramen is scraped out and the sigmoid sinus and the internal jugular vein are resected with the tumor either confined in the jugular foramen or extending out of the skull...
April 1982: No Shinkei Geka. Neurological Surgery
A Hakuba, S Nishimura, B J Jang
A combined retroauricular and preauricular transpetrosal-transtentorial approach is described for the resection of meningiomas arising from the clivus. Via radical mastoidectomy the sigmoid sinus is exposed down to the jugular bulb, and via the transmastoideal-subtemporal approach the retroauricular petrosal bone, 1 cm in depth from the petrosal ridge, and the roof of the internal auditory meatus are removed, the middle ear and fallopian canal being left intact. Additionally, via a transzygomatic-subtemporal approach the preauricular petrosal bone is removed anteriorly up to the petrosal tip and laterally as far as the petrosal portion of the internal carotid artery, while the cochlea is preserved...
August 1988: Surgical Neurology
R F Canalis, K Black, N Martin, D Becker
In this communication, an extension of the retrolabyrinthine approach that has permitted safe, effective access to the petrous tip and clivus is presented. The basic technique involved complete mastoidectomy, preservation of the middle and inner ear structures, removal of the sigmoid and middle fossa plates, middle and posterior fossa craniotomies, ligation of the superior petrosal sinus, and division of the tentorium. Nine cases that exemplified the versatility of this approach constituted the basis of this paper: 2 cholesteatomas, 2 basilar artery aneurysms, 2 chordomas, and 3 meningiomas...
January 1991: Laryngoscope
E L Hendershot, J W Wood, D Bennhoff
Petrositis is still a very real complication of otitis media. The most striking diagnostic feature is facial and/or retrobulbar pain, and it is the most consistent symptom. External rectus paralysis was present in only one of the four cases presented in this series. Treatment is surgical. In order to spare the cochlea and give adequate exposure to the apical cells, the middle fossa approach to the petrous apex is presented, to be used alone or in conjunction with mastoidectomy.
May 1976: Laryngoscope
W F House, A De la Cruz, W E Hitselberger
The transcochlear approach is described for resection of lesions arising anterior or medial to the internal auditory canal as well as for those arising directly from the clivus. Through an extended complete mastoidectomy the facial nerve is totally decompressed and re-routed posteriorly from the stylomastoid foramen to the internal auditory canal. The fallopian canal, promontorium, and cochlea are removed anteriorly and medially as far as the internal carotid artery, obtaining exposure to a triangular area limited by the superior petrosal sinus, inferior petrosal sinus, carotid, and internal auditory canal, giving adequate exposure to the structures of the clivus and the midline (basilar artery, vertebral arteries, and the sixth cranial nerves)...
September 1978: Otolaryngology
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