A Combined Technique for Investigation of the Cerebello-Pontine Angle Cistern and Internal Auditory Canal

Morris, Leon; Wylie, Ian

doi:10.2214/ajr.122.3.560

Cited by 2 publications

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“…The advent of computerized axial tomography, while revolutionizing the comfort and safety of diagnosis, has not yet solved this problem. There is still a need for tomographic contrast radiology of the type described by Morris & Wylie (1974) for the demonstration of intracanalicular and smaller angle filling defects.When we come to consider large tumours which have distorted or displaced the brain-stem and which are frequently associated with raised intracranial pressure, the translabyrinthine 1 Paper read to Sectionof Otology at Brighton, 2SJune 1977 0141.0768/78 …”

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Translabyrinthine Surgical Approach to the Internal Acoustic Meatus

Morrison

1978

J R Soc Med

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A good surgical approach should offer adequate access to manage the pathology and possible complications; it should be capable of modification to suit the circumstances; and it should be relatively devoid of risk. This versatility is to be found in the translabyrinthine approach to the internal acoustic meatus and cerebellopontine angle if combined, when necessary, with a modified transtentorial dissection.Acoustic neuroma surgery The translabyrinthine approach was first suggested by Panse (1904) and it was performed in 1912 by Quix and later by others. Though Cushing (1917) foresaw combined surgical attacks on this area, he condemned the translabyrinthine operation (Cushing 1921) and it fell into disrepute. For the next forty years the suboccipital operation described by Dandy (1925) was predominantly used, and even today it is preferred by many neurosurgeons. Ironically it is returning to favour with neurosurgeons and otologists since, in the management of smaller vestibular schwannomas, it offers the prospect of preservation of hearing as well as of facial nerve function following total tumour removal (Smith 1977). Regrettably, however, many patients when first seen have large tumours which are not amenable to such preservation, and even among the group with smaller tumours the hearing loss is frequently so severe that there would be little point in attempting to maintain it. Furthermore, Morrison et al. (1976) have drawn attention to the fact that some schwannomas, whatever their nerve or origin, are surgically inseparable from the cochlear division of the VIII cranial nerve; this applied to nearly one in four.House (1964) and Hitselberger & House (1966) pioneered the modern revival of the translabyrinthine operation which, assisted by microsurgical dissection, antibiotics, steroids and by good anaesthesia, is now practised by teams of otologists and neurosurgeons in many centres throughout the world. With increasing experience, surprisingly large tumours can be removed totally by the translabyrinthine approach. The principal advantage is in the surgical management of small and medium-sized tumours when there is very little risk of mortality or morbidity even to the facial nerve (Table I). When the otologist becomes involved in the surgical treatment of these lesions, his searching for smaller tumours is likely to be more enthusiastic and persevering. The advent of computerized axial tomography, while revolutionizing the comfort and safety of diagnosis, has not yet solved this problem. There is still a need for tomographic contrast radiology of the type described by Morris & Wylie (1974) for the demonstration of intracanalicular and smaller angle filling defects.When we come to consider large tumours which have distorted or displaced the brain-stem and which are frequently associated with raised intracranial pressure, the translabyrinthine 1 Paper read to Sectionof Otology at Brighton, 2SJune 1977 0141.0768/78

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