Expanded transcanal transpromontorial approach to the internal auditory canal: Pilot clinical experience

Presutti, Livio; Alicandri‐Ciufelli, Matteo; Bonali, Marco; Rubini, Alessia; Pavesi, Giacomo; Feletti, Alberto; Masotto, Barbara; Anschuetz, Lukas; Marchioni, Daniele

doi:10.1002/lary.26559

Cited by 41 publications

(40 citation statements)

References 19 publications

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“…46 HRJBs can make endoscopic access to the IAC very difficult in certain cases, just like in other skull base approaches to the region. 21,30,34 We feel that the currently proposed classification can offer safer and more efficacious surgical planning to the described region. In Manjila and Semaan classification types 1 and 2, a transpetrous approach to the posterior fossa (translabyrinthine approach) provides adequate exposure given adequate skeletonization of the sigmoid sinus and dome of the jugular bulb is performed.…”

Section: Typementioning

confidence: 97%

Jugular bulb and skull base pathologies: proposal for a novel classification system for jugular bulb positions and microsurgical implications

Manjila

Bazil

Kay

et al. 2018

Neurosurgical Focus

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OBJECTIVEThere is no definitive or consensus classification system for the jugular bulb position that can be uniformly communicated between a radiologist, neurootologist, and neurosurgeon. A high-riding jugular bulb (HRJB) has been variably defined as a jugular bulb that rises to or above the level of the basal turn of the cochlea, within 2 mm of the internal auditory canal (IAC), or to the level of the superior tympanic annulus. Overall, there is a seeming lack of consensus, especially when MRI and/or CT are used for jugular bulb evaluation without a dedicated imaging study of the venous anatomy such as digital subtraction angiography or CT or MR venography.METHODSA PubMed analysis of “jugular bulb” comprised of 1264 relevant articles were selected and analyzed specifically for an HRJB. A novel classification system based on preliminary skull base imaging using CT is proposed by the authors for conveying the anatomical location of the jugular bulb. This new classification includes the following types: type 1, no bulb; type 2, below the inferior margin of the posterior semicircular canal (SCC), subclassified as type 2a (without dehiscence into the middle ear) or type 2b (with dehiscence into the middle ear); type 3, between the inferior margin of the posterior SCC and the inferior margin of the IAC, subclassified as type 3a (without dehiscence into the middle ear) and type 3b (with dehiscence into the middle ear); type 4, above the inferior margin of the IAC, subclassified as type 4a (without dehiscence into the IAC) and type 4b (with dehiscence into the IAC); and type 5, combination of dehiscences. Appropriate CT and MR images of the skull base were selected to validate the criteria and further demonstrated using 3D reconstruction of DICOM files. The microsurgical significance of the proposed classification is evaluated with reference to specific skull base/posterior fossa pathologies.RESULTSThe authors validated the role of a novel classification of jugular bulb location that can help effective communication between providers treating skull base lesions. Effective utilization of the above grading system can help plan surgical procedures and anticipate complications.CONCLUSIONSThe authors have proposed a novel anatomical/radiological classification system for jugular bulb location with respect to surgical implications. This classification can help surgeons in complication avoidance and management when addressing HRJBs.

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Section: Typementioning

confidence: 97%

Jugular bulb and skull base pathologies: proposal for a novel classification system for jugular bulb positions and microsurgical implications

Manjila

Bazil

Kay

et al. 2018

Neurosurgical Focus

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“…Marchioni et al (11) reported no CSF leakage after exclusive ETTA. In Presutti et al study (16), 1 of 10 patients underwent expanded ETTA experienced postoperative CSF otorhinorrhea, which completely resolved in the follow-up period. Wick et al (3) reported no postoperatively complication after ETTA on 4 patients with vestibular schwannomas.…”

Section: Discussionmentioning

confidence: 92%

“…The mean hospital stay was 2.8 days in this study. Presutti et al (16) concluded that expanded ETTA (using both endoscope and microscope, which allows bimanual dissection of the tumor and therefore, enhanced control of the surrounding neurovascular structures) was successful in the management of 10 patients with vestibular schwannoma Koos stage I or II with no facial dysfunction in the last follow-up. Marchioni et al (9) described the expanded ETTA for the successful resection of vestibular schwannoma in patients with Koos grade II and III with no complication and good facial nerve result and concluded that this technique was a new approach that combined the advantages of a microscopic technique with the ones offered by the endoscope.…”

Section: Discussionmentioning

confidence: 99%

Surgical Landmarks of the Endoscopic Transcanal Transcochlear Approach: A Cadaveric Study

et al. 2019

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Background: The lateral skull base lesions are one of the most challenging parts of the head and neck. Surgical approaches for this area are complex and difficult. Although endoscopic approaches in skull base surgeries have progressed dramatically in recent years, there are few studies concerning these approaches. Objectives: This study aimed to describe the endoscopic transcanal transcochlear approach (ETTA) to reach the internal auditory canal (IAC) in the cadaveric temporal bone specimen. Methods: First, pre-and post-operative high resolution computed tomography (HRCT) images of the transcanal transcochlear pathway were obtained and 3D segmentation was performed using 3D Slicer software. The anatomic landmarks were identified using the endoscopic approach with and without navigation guide. Surgeries were done and the feasibility and challenges were evaluated. Results: The internal auditory canal (IAC) was accessed via the ETTA. Anatomic landmarks were looked and a surgical corridor was identified with HRCT segmentations and images obtained during surgery. Conclusions: We tried to increase our learning curve and extend surgical experience in lateral skull base surgery via minimally invasive ETTA. The increased endoscopic skills and the use of auxiliary tools such as a navigation guide may be helpful for successful access to the lateral skull base.

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“…A good pictorial view of the excavated mastoid segment of facial nerve through transcanal route was found in L. Presutti et al work. 9 Butthe details of such dissection were not mentioned there. In author's own previous work, the mastoid segment of facial nerve had also been exposed through the transcanal endoscopic mastoidectomy approach.…”

Section: Discussionmentioning

confidence: 99%

Transcanal Endoscopic Approach to the Mastoid Segment of Facial Nerve and the Role of the Pyramidal Eminence as a Landmark

Kamal¹

2020

Bangladesh J of Otorhinolaryngology

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Objectives: To study the feasibility of approaches in addressing the mastoid segment of facial nerve through transcanal route exclusively under endoscopic guidance and to verify the usefulness of the pyramidal eminence as a landmark. Study design: The prospective experimental study Setting: “Transcanal endoscopic temporal bone dissection lab” situated in the Surgiscope hospital, Chittagong, Bangladesh. Materials: 4 (Four) cadaveric temporal bones. Interventions: Two pure transcanal endoscopic approaches were applied to excavate the mastoid segment of facial nerve. In anterior-medial approach, the dissection was progressed from medial to the lateral direction through the retrotympanum focusing the anterior-medial side of the mastoid segment of facial nerve. Whereas in anterior-lateral approach, the dissection was progressed from lateral to the medial direction through the posterior canal wall focusing the anterior-lateral side of the mastoid segment of facial nerve. In both approaches, the pyramidal eminence was considered as an anatomical landmark to navigate the dissection for the excavation of the mastoid segment of facial nerve. Main outcome measures: The efficacy of each approach in respect of the complete excavation of the mastoid segment of facial nerve and the worthiness of the pyramidal eminence as the landmark for navigating the dissection. Results: In both transcanal endoscopic approaches, the entire mastoid segment of facial nerve could be exposed successfully. But in anterior-medial approach, the chorda tympani nerve was needed to be sacrificed. The search of the mastoid segment of facial nerve with the guidance of the pyramidal eminence was observed as effective and safe. Conclusion: The entire mastoid segment of facial nerve could be successfully addressed through transcanal route under pure endoscopic guidance. The pyramidal eminence has appeared as an important landmark for such endeavor. Bangladesh J Otorhinolaryngol; October 2019; 25(2): 108-115

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Expanded transcanal transpromontorial approach to the internal auditory canal: Pilot clinical experience

Abstract: 4. Laryngoscope, 127:2608-2614, 2017.

Cited by 41 publications

References 19 publications

Jugular bulb and skull base pathologies: proposal for a novel classification system for jugular bulb positions and microsurgical implications

Jugular bulb and skull base pathologies: proposal for a novel classification system for jugular bulb positions and microsurgical implications

Surgical Landmarks of the Endoscopic Transcanal Transcochlear Approach: A Cadaveric Study

Transcanal Endoscopic Approach to the Mastoid Segment of Facial Nerve and the Role of the Pyramidal Eminence as a Landmark

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