The Transcrusal Approach

Brandt, Michael G.; Poirier, Justin; Hughes, Brian; Lownie, Stephen P.; Parnes, Lorne S.

doi:10.1227/01.neu.0000368102.22612.47

Cited by 20 publications

(6 citation statements)

References 17 publications

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“…With the lesion not conforming to these attributes, the surgeon may need to convert to a transcrusal/ translabyrinthine approach, to skeletonization/posterior displacement of the SS, or to undertake a retrosigmoid approach. 6 10…”

Section: Discussionmentioning

confidence: 99%

Study of Sigmoid Sinus Variations in the Temporal Bone by Micro Dissection and its Classification – A Cadaveric Study

Singh

Irugu

Sikka

et al. 2019

Int Arch Otorhinolaryngol

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Introduction Sigmoid sinus (SS) variations have been classified variously in the literature. These classifications suffer from some form of shortcoming from a clinical point of view for their application. Objective We propose a clinically relevant classification of the SS in relation to the posterior semicircular canal (PSCC) and to the exposure of the presigmoid dural plate. The positioning of the SS was analyzed with reference to the volume of the mastoid and to the level of mastoid pneumatization. Methods A total of 94 formalin-preserved human cadaveric temporal bones were microdissected to carry out a complete mastoidectomy. The SS, the presigmoid dural plate, and the PSCC were exposed, and the position of the former was analyzed in relation to the latter two in order to classify the position of the SS into three grades. Results Grade I had the best exposure of the presigmoid dura and of the PSCC, while grade III had the poorest exposure of the presigmoid dura and of the PSCC. Grade I SS was associated with good pneumatization and higher mastoid volumes compared with grades II and III. Conclusions The SS exhibits considerable anatomic variability. A favorable positioning of the SS is associated with a large mastoid volume and pneumatization. A careful preoperative study of the imaging may help in understanding the positioning of the SS and the safety of various transmastoid approaches.

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Section: Discussionmentioning

confidence: 99%

Study of Sigmoid Sinus Variations in the Temporal Bone by Micro Dissection and its Classification – A Cadaveric Study

Singh

Irugu

Sikka

et al. 2019

Int Arch Otorhinolaryngol

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“…Obliteration of the canals begins away from the ampullated end and proceeds with a leading edge maintaining a seal with a combination of either bone dust, bone wax and/or fibrin sealant. Preservation of serviceable hearing was possible in at least 58% of patients across published studies [ 10 – 12 ]. It is encouraging that even if complete exposure of the labyrinthine segment is required via a transcrusal approach, it may be possible to preserve sensorineural hearing.…”

Section: Discussionmentioning

confidence: 99%

Endoscopically-assisted transmastoid approach to the geniculate ganglion and labyrinthine facial nerve

Jufas

Bance

2017

Journal of Otolaryngology - Head & Neck Surgery

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BackgroundEndoscopic transcanal approaches to the facial nerve allow excellent exposure of the tympanic facial nerve. This approach becomes limited when access is required to the more proximal geniculate ganglion and labyrinthine portion of the facial nerve. The aim of this report was to determine the feasibility of a transmastoid endoscopically assisted approach to the geniculate ganglion and labyrinthine facial nerve. This is an endoscopic cadaveric dissection and video review at a university anatomical laboratory.MethodsA total of 12 endoscopic cadaveric dissections were performed. A cortical mastoidectomy and perilabyrinthine air cell removal was performed using an operating microscope. Beyond this, dissection was performed with an endoscope.ResultsIn all dissections, an endoscopically assisted transmastoid approach allowed complete access to the geniculate ganglion, and at least 1.5 mm of the distal labyrinthine facial nerve. Further transcrusal drilling through the anterior crus of the superior semicircular canal allowed access to the entire labyrinthine facial nerve.ConclusionsThe entire geniculate ganglion and labyrinthine facial nerve is difficult to access with microscopic techniques. Adding endoscopic visualization allows for complete visualization of the geniculate ganglion. Clinical reports will further strengthen these preliminary cadaveric results.

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“…The focal combined transpetrosal approach performed by the authors was described in detail previously. 4 It is based on: (1) small periauricular skin incision; (2) no bone flap elevation and precise drilling of the petrous (including the apex) and squamous parts of the temporal bone; (3) extensive middle fossa reverse dural peeling; (4) tentorial peeling; (5) no retractors on temporal lobe and cerebellum; and (6) minimal exposure of the brain parenchyma. The horizontal splitting of the tentorial dural layers adds further extradural access to the posterior and middle cranial fossa and protection to the temporal lobe and Labbé vein complex.…”

Section: Surgical Techniquementioning

confidence: 99%

“…However, over the years, it has been demonstrated that the violation of the labyrinthine structures, accidentally or intentionally, does not inexorably lead to hearing loss, and this has led to a re-examination of this problem by skull base surgeons. 1,2 The labyrinth obscures the view of the presigmoid space external and internal to the dura mater, which has a great impact on the visualization of deeper anatomic structures such as the abducens nerve and the basilar artery. 3 The present technical note proposes to describe a modification to the translabyrinthine approach with restricted removal of only the superior semicircular canal (SSC) during the focal combined petrosectomy.…”

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confidence: 99%

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Partial Labyrinth Removal Restricted to the Superior Semicircular Canal in Focal Combined Transpetrosal Approach: Description and Illustrative Cases

Vidal,

Figueiredo,

Hazin

et al. 2023

Operative Neurosurgery

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BACKGROUND AND OBJECTIVES: The labyrinthine structures obstruct the surgical view of the deep petroclival region in the transpetrosal approach. Historically, labyrinthectomy and removal of all 3 semicircular canals, with resultant deafness, was used in patients with ipsilateral functional hearing deficits to improve access. The advent and systematization of superior and posterior semicircular canal removal (transcrusal approach) with good rates of hearing preservation has allowed a redefinition of the possibility of partial labyrinthectomy in patients without previous hearing deficits. The present manuscript is intended to describe a technical refinement of partial labyrinthectomy during focal combined petrosectomy, offering a customization of the approach through the selective removal of the superior semicircular canal for specific types of tumors. METHODS: The use of the technique is demonstrated through surgical drawings, pictures, and videos. The rationale to indicate this new approach is discussed based on clinical cases. RESULTS: Three illustrative clinical cases (petroclival meningiomas) are demonstrated. Functional hearing on the approach side has been preserved in all of them. CONCLUSION: The focal combined transpetrosal approach associated with the superior semicircular canal resection has been a promising surgical technique in the treatment of selected petroclival tumors. It has the potential to further decrease the risks of postoperative auditory and vestibular dysfunctions associated with labyrinthectomies.

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The Transcrusal Approach

Cited by 20 publications

References 17 publications

Study of Sigmoid Sinus Variations in the Temporal Bone by Micro Dissection and its Classification – A Cadaveric Study

Study of Sigmoid Sinus Variations in the Temporal Bone by Micro Dissection and its Classification – A Cadaveric Study

Endoscopically-assisted transmastoid approach to the geniculate ganglion and labyrinthine facial nerve

Partial Labyrinth Removal Restricted to the Superior Semicircular Canal in Focal Combined Transpetrosal Approach: Description and Illustrative Cases

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