Cosmetic Reconstruction after Mastoidectomy for the Transpetrosal-Presigmoid Approach: Technical Note

Tokoro, Kazuhiko; Chiba, Yasuhiro; Murai, Masanori; Hayashi, Akimune; Kyuma, Yoshikazu; Fujii, Satoshi; Yamamoto, Isao

doi:10.1097/00006123-199607000-00044

Cited by 16 publications

(7 citation statements)

References 14 publications

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“…This mesh-apatite construct provides a tamponade effect, stabilizing the fat graft laid over the dura and waxed antrum. 26,45,55 The described technique of using a titanium mesh provides this uniform steady pressure when the mesh is pushed down over the fat graft, which in turn provides room for HAC application that contours the retroauricular bony defect. The titanium mesh is bowed medially after screwing at 2 points to contour and stabilize the A temporalis fascia graft is placed over a layer of Duragen and TISSEEL sealant, which is applied initially over the internal auditory canal (IAC) dural and posterior fossa defect.…”

Section: Discussionmentioning

confidence: 99%

“…Cosmetic mastoidectomy was employed to cover larger defects in posterior petrosectomies in the 1990s. 18,25,43,49,54,55 However, the outer table of mastoid bone needed for a posttranslabyrinthine defect is smaller; therefore, it is cumbersome to perform a cortical bone flap such as those described for larger petrosectomies. Even if a rongeur or air drill were used, there would still be a circumferential bony defect around the bone flap, and it would be wide enough to require sealing and miniplate fixation.…”

Section: Cosmetic Mastoidectomy-local Autograft?mentioning

confidence: 99%

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Prevention of postoperative cerebrospinal fluid leaks with multilayered reconstruction using titanium mesh–hydroxyapatite cement cranioplasty after translabyrinthine resection of acoustic neuroma

Manjila¹,

Weidenbecher

Semaan

et al. 2013

JNS

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PostoPerative CSF leak after translabyrinthine surgery for removal of an acoustic neuroma (TLAN) is recognized as an infrequent complication, despite the best prophylactic techniques currently available. [29][30][31][32][33]36,40,44 To prevent postoperative CSF leaks after TLAN, several surgical methods have been tried, using different autografts and allografts, alone or in combinations, with varying success rates. 6,8,10,11,13,[22][23][24]27,28,42,46 These range from calvarial bone autografts, bone cements, metals, and resins to resorbable bone plates. 5,6,51 Calvarial grafts can be time consuming and less malleaPrevention of postoperative cerebrospinal fluid leaks with multilayered reconstruction using titanium mesh-hydroxyapatite cement cranioplasty after translabyrinthine resection of acoustic neuroma Object. Several prophylactic surgical methods have been tried to prevent CSF leakage after translabyrinthine resection of acoustic neuroma (TLAN). The authors report an improvised technique for multilayer watertight closure using titanium mesh-hydroxyapatite cement (HAC) cranioplasty in addition to dural substitute and abdominal fat graft after TLAN.Methods. The study was limited to 42 patients who underwent TLAN at University Hospitals Case Medical Center using this new technique from 2006 to 2012. Systematic closure of the surgical wound in layers using temporalis fascia, dural substitute, dural sealant, adipose graft, titanium mesh, and then HAC was performed in each case. Temporalis muscle and eustachian tube obliteration were not used. The main variables studied were patient age, tumor size, tumor location, cosmetic outcome, length of hospitalization, and the incidence of CSF leak, pseudomeningocele, and infection.Results. Excellent cosmetic outcome was achieved in all patients. There were no cases of postoperative CSF rhinorrhea, incisional CSF leak, or meningitis. Cosmetic results were comparable to those achieved using HAC alone. This cost-effective technique used only a third of the HAC required for traditional closure in which the entire mastoid defect is filled with cement, predisposing to infection. Postoperative CT and MRI showed excellent bony contouring and dural reconstitution, respectively.Conclusions. The authors report on successful use of titanium mesh-HAC cranioplasty in preventing postoperative CSF leak after TLAN in all cases in their series. The titanium mesh provides a well-defined anatomical dissection plane that would make reoperation easier than working through scarred soft tissue. The mesh bolsters the fat graft and keeps HAC out of direct contact with mastoid air cells, thereby reducing the risk of infection. The cement cranioplasty does not preclude subsequent implantation of a bone-anchored hearing aid.

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Section: Discussionmentioning

confidence: 99%

Section: Cosmetic Mastoidectomy-local Autograft?mentioning

confidence: 99%

Prevention of postoperative cerebrospinal fluid leaks with multilayered reconstruction using titanium mesh–hydroxyapatite cement cranioplasty after translabyrinthine resection of acoustic neuroma

Manjila¹,

Weidenbecher

Semaan

et al. 2013

JNS

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“…Resekcja czêoeci sutkowej kooeci skroniowej daje pewnego stopnia defekt kosmetyczny. Trzy zespo³y chirurgiczne [38][39][40] podjê³y próby ograniczenia tego defektu. Pierwsza polega na przywróceniu w anatomiczne po³o¿enie p³ytki kostnej, która od ty³u pokrywa czêoeae sutkow¹.…”

Section: Omówienieunclassified

“…Postêpowanie takie grozi uszkodzeniem zatok opony twardej, b³êdnika i nerwu twarzowego. Trzecia koncepcja [40] zak³ada usuwanie czêoeci sutkowej kooeci skroniowej za pomoc¹ narzêdzi kostnych, co pozwala na uzys -kanie licznych, drobnych fragmentów kostnych. Fragmenty te, pomieszane z klejem tkankowym, zostaj¹ przywrócone w czasie zamkniêcia w anatomiczne po³o¿enie wyrostka sutkowatego.…”

Section: Omówienieunclassified

Dostęp skalisty tylny – analiza techniki operacyjnej na podstawie symulacji na zwłokach

Ładziński

Maliszewski

Kaspera

et al. 2013

Neurologia i Neurochirurgia Polska

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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. Posterior petrosal approach is a reproducible technique, which provides surgical penetration of the middle clivus and related regions. It reduces the operating distance and allows to limit the cerebellum and temporal lobe traction and to preserve the anatomic integrity of the brain stem and cranial nerves of the cerebellopontine angle.

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“…Tokoro et al [27] described the technique of cosmetic reconstruction after mastoidectomy using bone chips mixed with fibrin glue. This may be adequate in standard mastoid obliteration for chronic ear disease; it will not likely provide a rigid platform to compress and medialize the fat graft following a translabyrinthine procedure.…”

Section: Nonvascularized Bone Graftsmentioning

confidence: 99%

Reconstructive options for skull defects following translabyrinthine surgery for vestibular schwannomas

Yuen

Chen

2008

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Cosmetic Reconstruction after Mastoidectomy for the Transpetrosal-Presigmoid Approach: Technical Note

Abstract: We have developed a simple and easy technique of cosmetic reconstruction after the transpetrosal-presigmoid approach.

Cited by 16 publications

References 14 publications

Prevention of postoperative cerebrospinal fluid leaks with multilayered reconstruction using titanium mesh–hydroxyapatite cement cranioplasty after translabyrinthine resection of acoustic neuroma

Prevention of postoperative cerebrospinal fluid leaks with multilayered reconstruction using titanium mesh–hydroxyapatite cement cranioplasty after translabyrinthine resection of acoustic neuroma

Dostęp skalisty tylny – analiza techniki operacyjnej na podstawie symulacji na zwłokach

Reconstructive options for skull defects following translabyrinthine surgery for vestibular schwannomas

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