A modified extended middle cranial fossa approach for acoustic nerve tumors

Shiobara, Ryuzo; Ohira, Takayuki; Kanzaki, Jin; Toya, Shigeo

doi:10.3171/jns.1988.68.3.0358

Cited by 66 publications

(8 citation statements)

References 31 publications

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“…It also plays an important role in the surgical management of the relatively newly described superior semicircular canal (SCC) dehiscence syndrome [2]. The extended MCF and combined transpetrosal-transtentorial approaches are now also used for management of skull base lesions and posterior circulation cerebral aneurysms [3,4,5]. …”

Section: Introductionmentioning

confidence: 99%

Radiographic Assessment and Surgical Implications of Arcuate Eminence Pneumatization

Samy

Pensak

2015

ORL

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Background: The middle cranial fossa (MCF) approach is a valuable yet technically challenging technique. Identification of the superior semicircular canal (SCC) using the arcuate eminence (AE) was proposed as a surface landmark. However, the AE is sometimes absent, with inconsistent relationship to the SCC. Air cells in the AE area facilitate safer identification of the SCC. The aim of this study is to determine the radiographic prevalence of AE pneumatization. Methods: Two hundred consecutive fine-cut temporal bone CT scans were retrospectively reviewed. The region of the petrosal bone at and above the level of the SCC dome was assessed for the presence of air cells, and graded 0 (no pneumatization) to 2 (well pneumatized). Results: Four hundred temporal bones were studied. The average age was 49 years (range 18-89). Of all AE assessments, 47 (12%) were nonpneumatized, 62 (15%) partially pneumatized, and 291 (73%) well pneumatized. There was no significant correlation between patient age and pneumatization grade (p = 0.72). Conclusion: The SCC is a valuable landmark in MCF surgery as it holds consistent relationships to adjacent critical structures. Surrounding air cells should facilitate safer initial identification of the SCC, as the AE region is well pneumatized in 73% of patients.

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Section: Introductionmentioning

confidence: 99%

Radiographic Assessment and Surgical Implications of Arcuate Eminence Pneumatization

Samy

Pensak

2015

ORL

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“…16 The lateral skull base approaches via the temporal bone have been modified to enhance exposure of the petroclival area. 8,[17][18][19][20][21][22][23][24] With bony resection of the petrous bone, several modifications have been useful to obtain wide exposure of the petroclival area. The temporomandibular joint was exposed to increase the width and ease of surgical access to the anterior petrous region.…”

Section: Discussionmentioning

confidence: 99%

Commentary

Erkmen¹,

Al‐Mefty²

2006

Skull Base

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In the management of skull base chordomas, surgical treatment is essential to achieve long-term control. A petroclival chordoma growing laterally in the skull base is one of the most challenging tumors for neurosurgeons. We have treated petroclival chordomas based on the principle of maximal surgical resection of the tumor with minimal morbidity. Lateral skull base approaches were used to approach petroclival chordomas in eight patients. The surgical procedure involved removal of soft tumor tissue and extensive drilling of adjacent bony structures. Gross total resection of the tumor was achieved in six patients. Subtotal resection in the remaining two patients was associated with acceptable morbidity. In cases of petroclival chordomas, lateral skull base approaches can be used as a primary procedure, although those approaches may be associated with high rates of morbidity and mortality.

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“…This excessive retraction of the temporal lobe often induces cerebral contusions or venous infarction. 2 In approaching an acoustic neurinoma using the extended middle cranial fossa approach [2][3][4][5] or a basilar trunk aneurysm using the transpetrosal approach, 6 resectioning of the petrosal bone is required, but the roof of the external auditory meatus will not be obstructed. But for approaching those lesions situated lower than the tentorial edge, [2][3][4][5][6] removal of the roof of the external auditory meatus is helpful because it enlarges the surgical entry space (Fig.…”

Section: Discussionmentioning

confidence: 99%

Enlarged Entry Space for the Transpetrosal Approach

Sato¹,

Oizumi²,

Sato³

et al. 2000

Skull Base

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An important consideration in neurosurgical procedures is avoiding retraction of the brain. Sindou and Fobe' reported on the usefulness of removing the roof of the external auditory meatus to avoid the excessive retraction of the temporal lobe or to prevent damage to the venous sinus and Labbe's vein while approaching the tentorial edge. this surgical approach is used for treatment at the tentorial notch, but in our surgical experience with cerebropontine angle lesions, it is also useful for posterior fossa lesions and upper clival lesions. In approaching acoustic neurinomas by the extended middle cranial fossa,24 we found this method to be useful in accessing not only a tentorial lesion but one situated lower than the tentorium. There has been some confusion about the extent of removal of the roof of the external auditory meatus. We report on the extent of bone removed in cadavers. METHODSWith a transtentorial transpetrosal approach to a lesion lower than the tentorium, the operative field is very deep and limited, but with a removal of the roof of the external auditory meatus, the entry zone is enlarged and the lesion is more easily accessible (Fig. 1). The 59 Skull Base Surgery, Volume 10, Number

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A modified extended middle cranial fossa approach for acoustic nerve tumors

Cited by 66 publications

References 31 publications

Radiographic Assessment and Surgical Implications of Arcuate Eminence Pneumatization

Radiographic Assessment and Surgical Implications of Arcuate Eminence Pneumatization

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Enlarged Entry Space for the Transpetrosal Approach

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