Surgical anatomy of the facial nerve: from middle cranial fossa approach to endoscopic approach. A pictorial review

Totally endoscopic transcanal facial nerve decompression in patients with traumatic facial nerve paralysis: from geniculate ganglion to mastoid segment

“…The middle cranial fossa approach is a well-established route for addressing the labyrinthine segment, geniculate ganglion and proximal portion of the tympanic segment, and allows preservation of hearing function. 14 Because of the anatomical complexity of this area, this approach should be performed by an expert surgeon. Nevertheless, this approach involves craniotomy and temporal lobe retraction, with the potential associated risks of brain oedema, haematoma (subdural, subarachnoid and parenchymal), seizure, cerebrospinal fluid (CSF) leakage, meningitis and brain abscess.…”

“…Nevertheless, this approach involves craniotomy and temporal lobe retraction, with the potential associated risks of brain oedema, haematoma (subdural, subarachnoid and parenchymal), seizure, cerebrospinal fluid (CSF) leakage, meningitis and brain abscess. 14,15 Bento et al evaluated the results of the middle cranial fossa approach for traumatic facial nerve injury in 156 patients. They reported complications in 23 patients: CSF leakage in 8 patients, epidural haematoma in 4, meningitis in 4 patients, sensorineural hearing loss in 4 and seizure in 3 patients.…”

“…20,25 The translabyrinthine approach to the facial nerve can provide wide access to the labyrinthine and tympanic segments, and to the mastoid segment when combined with a transmastoid approach, but hearing is sacrificed; the approach is thus reserved for patients with pre-operative profound sensorineural hearing loss. 14 Recently, with the improvement of our anatomical knowledge and experience in endoscopic middle-ear surgery, endoscopic transcanal ear surgery is being performed more frequently. Furthermore, different types of ear surgery are being performed using an endoscope, with comparable results to those of traditional microscopic procedures.…”

“…23 Endoscopic transcanal facial nerve decompression is a minimally invasive approach allowing direct exposure of the geniculate ganglion, tympanic segment and the second genu of the facial nerve. 14 In the current study, endoscopic transcanal facial nerve decompression was used to approach the geniculate ganglion, tympanic segment, second genu and mastoid segment of the facial nerve. This technique obviates the need for excessive mastoid air cell removal and shortens the operating time.…”

“…Nevertheless, this approach involves craniotomy and temporal lobe retraction, with the potential associated risks of brain oedema, haematoma (subdural, subarachnoid and parenchymal), seizure, cerebrospinal fluid (CSF) leakage, meningitis and brain abscess. 14,15…”