Lateral Skull Base Surgery: The Otology Group Experience

Manolidis, Spiros; Jackson, C. Gary; Doersten, Peter G. Von; Pappas, Dennis G.; Glasscock, Michael E.

doi:10.1055/s-2008-1058604

Cited by 19 publications

(9 citation statements)

References 29 publications

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“…Due to these factors, the resulting morbidity and mortality with external approaches can be high. 3,[18][19][20][21][22] In an attempt to refine skull base techniques, minimally invasive surgery has been a hot topic of interest. Surgical experience, anatomical knowledge, and advanced microsurgical instrumentation have allowed increased success in terms of patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

Subtemporal Retrolabyrinthine (Posterior Petrosal) versus Endoscopic Endonasal Approach to the Petroclival Region: An Anatomical and Computed Tomography Study

et al. 2015

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Background The petroclival region seats many neoplasms. Traditional surgical corridors to the region can result in unacceptable patient morbidity. The combined subtemporal retrolabyrinthine transpetrosal (posterior petrosal) approach provides adequate exposure with hearing preservation; however, the facial nerve and labyrinth are put at risk. Approaching the petroclival region with an endoscopic endonasal approach (EEA) could minimize morbidity. Objective To provide an anatomical and computed tomography (CT) comparison between the posterior petrosal approach and EEA to the petroclival region. Methods The petroclival region was approached transclivally with EEA. Different aspects of dissection were compared with the posterior petrosal approach. The two approaches were also studied using CT analysis. Results A successful corridor medial to the internal auditory canal (IAC) was achieved with EEA. Wide exposure was achieved with no external skin incisions, although significant sinonasal resection was required. The posterior petrosal was comparable in terms of exposure medially; however, the dissection involved more bone removal, greater skill, and a constricting effect upon deeper dissection. Importantly, access lateral to the IAC was obtained, whereas EEA could not reach this area. Conclusion An EEA to the petroclival region is feasible. This approach can be considered in lesions medial to the IAC.

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Section: Discussionmentioning

confidence: 99%

Subtemporal Retrolabyrinthine (Posterior Petrosal) versus Endoscopic Endonasal Approach to the Petroclival Region: An Anatomical and Computed Tomography Study

et al. 2015

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“…The group in our series with the greatest number of complexities included cases with malignancies of the petrous bone, of the parotid or skin, or of the infratemporal spaces with infiltration of the petrous bone. Extensive surgery is often necessary in these cases, including petro‐sectomy, parotidectomy, and infratemporal tumor extirpation 18 . Facial nerve grafting had to be performed over quite long distances.…”

Section: Discussionmentioning

confidence: 99%

Facial Nerve Function After Petrosectomy

1999

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“…If intracranial extension was involved, the percentage of lesions classified as Fisch Type D was calculated as 18.7% in 530 lesions, 21 and our value (84.3%) was also higher than in other studies (range 33%-72%). 19,28,36,38,47 The severity of intracranial extension and ICA involvement were proven to be significant influential factors for resection. 32 If both the ICA and pars nervosa were infiltrated, GTR without morbidity was extremely challenging, especially in previously treated or irritated lesions.…”

Section: Neurological Function Outcomes and Risksmentioning

confidence: 99%

Less-aggressive surgical management and long-term outcomes of jugular foramen paragangliomas: a neurosurgical perspective

Zeng

Hao

et al. 2016

JNS

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OBJECTIVE The aim of this study was to analyze the neurological functional outcome and recurrent risks in surgically treated jugular foramen paragangliomas (JFPs) and to propose an individualized therapeutic strategy. METHODS Clinical charts and radiological information were reviewed retrospectively in 51 consecutive cases of JFPs. Less-aggressive surgical interventions were adopted with the goal of preserving neurovascular structures. Scheduled follow-up was performed. RESULTS The mean age of the patients in the cases reviewed was 41.6 years, and the group included 27 females (52.9%). The mean preoperative Karnofsky Performance Scale (KPS) score was 78.4. The mean lesion size was 3.8 cm. Forty-three cases (84.3%) were Fisch Type D, including 37 cases (72.5%) of Type Di1 and Di2. Thirty-seven cases (72.5%) were Glasscock-Jackson Type III-IV. Gross-total resection and subtotal resection were achieved in 26 (51.0%) and 22 (43.1%) cases, respectively. Surgical morbidities occurred in 23 patients (45.1%), without surgery-related mortality after the first operation. The mean postoperative KPS scores at discharge, 3 months, 1 year, and most recent evaluation were 71.8, 77.2, 83.2, and 79.6, respectively. The mean follow-up duration was 85.7 months. The tumor recurrence/regrowth (R/R) rate was 11.8%. Compared with preoperative status, swallowing function improved or stabilized in 96.1% and facial function improved or stabilized in 94.1% of patients. A House-Brackmann scale Grade I/II was achieved in 43 patients (84.3%). Overall neurological status improved or stabilized in 90.0% of patients. Pathological mitosis (HR 10.640, p = 0.009) was the most significant risk for tumor R/R. A 1-year increase in age (OR 1.115, p = 0.037) and preoperative KPS score < 80 (OR 11.071, p = 0.018) indicated a risk for recent poor neurological function (KPS < 80). Overall R/R-free survival, symptom progression-free survival, and overall survival at 15 years were 78.9%, 86.8%, and 80.6%, respectively. CONCLUSIONS Surgical outcomes for JFPs were acceptable using a less-aggressive surgical strategy. Most patients could adapt to surgical morbidities and carry out normal life activities. Preserving neurological function was a priority, and maximal decompression with or without radiotherapy was desirable to preserve a patient's quality of life when radical resection was not warranted. Early surgery plus preoperative devascularization was proposed, and radiotherapy was mandatory for lesions with pathological mitosis.

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Lateral Skull Base Surgery: The Otology Group Experience

Abstract: Skull base surgery is a young surgical discipline that has seen a tremendous evolution in the last 20 years. The

Cited by 19 publications

References 29 publications

Subtemporal Retrolabyrinthine (Posterior Petrosal) versus Endoscopic Endonasal Approach to the Petroclival Region: An Anatomical and Computed Tomography Study

Subtemporal Retrolabyrinthine (Posterior Petrosal) versus Endoscopic Endonasal Approach to the Petroclival Region: An Anatomical and Computed Tomography Study

Facial Nerve Function After Petrosectomy

Less-aggressive surgical management and long-term outcomes of jugular foramen paragangliomas: a neurosurgical perspective

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