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CHOLESTEATOMA AND MASTOID SURGERY proceedings of the fifth International Conference on Cholesteatoma and Mastoid Surgery, Alghero, Sardinia (Italy), September 1-6, 1996
No full textA posterolateral approach to the skull base: the petro-occipital transsigmoid approach.
No full textThis posterolateral approach is directed to the petro-occipital skull base and is a combination of a suboccipital craniotomy, with an inferoposterior petrosectomy. The areas exposed are the jugular foramen, occipital condyle, lower clivus to the midline, petrous apex, tympanic cavity, the vertical portion of the intrapetrous carotid artery below the level of the eustachian tube, cerebellopontine angle, the jugulocarotid space in the upper neck. We evaluated 45 cases as follows: 13 chemodectomas, 14 lower cranial nerve schwannomas, 10 meningiomas, and 8 other lesions. The approach is indicated for extra-, intra-, and transdural lesions of the jugular foramen area. The transdural lesions could be extirpated in a single procedure without cerebrospinal fluid leak. This, in addition to preservation of the facial nerve, middle and inner ear functions, constituted the main advantages of this approach. Lower cranial nerve deficit formed the major morbidity in the present series and is still an unsolved problem in such cases
Subtemporal exposure of the intrapetrous internal carotid artery. An anatomical study with surgical application.
No full textThis work describes the exposure of the intrapetrous internal carotid artery (ICA) through the subtemporal approach. The anatomical details of 25 fresh temporal bones were studied and provided the initial background for this procedure. Bone drilling in the meatal plane anterior to the internal auditory canal could create a four-sided quadrangular area. The exposure of the ICA through this area was applied on three occasions. It proved safe as regards the surrounding structures and also provided an ample working space for the extirpation of tumours surrounding the artery
Ossicular chain preservation in epitympanic cholesteatoma surgery: the modified Bondy technique.
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Surgical management of lesions of the internal carotid artery using a modified Fisch Type A infratemporal approach.
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Nerve origin of vestibular schwannoma: a prospective study.
No full textOBJECTIVE:
The origin of vestibular schwannoma has always been a matter of debate. The aim of our study was to identify the nerve origin of this tumour.
STUDY DESIGN:
Prospective case review. This study was conducted at Gruppo Otologico, a private referral centre for neurotology and skull base surgery.
METHODS:
A total of 200 cases of vestibular schwannoma were included in the study. All the tumours were removed surgically utilising the translabyrinthine approach. The origin of the tumour was sought at the fundus of the internal auditory canal.
RESULTS:
A total of 200 consecutive cases was included in the study. The origin of the tumour was limited to one nerve at the fundus in 152 cases (76 per cent). Out of these cases, the tumour originated from the inferior vestibular nerve in 139 cases (91.4 per cent), from the superior vestibular nerve in nine cases (6 per cent), from the cochlear nerve in two cases (1.3 per cent) and from the facial nerve in two cases (1.3 per cent).
CONCLUSION:
The vast majority of vestibular schwannomas originate from the inferior vestibular nerve; the incidence of involvement of this nerve increases as the tumour size increases. An origin of vestibular schwannoma from the inferior vestibular nerve can be considered as one of the explanatory factors for the poor functional outcome of the extended middle cranial fossa approach, and probably accounts also for the better hearing preservation rate reported in some series for the retrosigmoid approach
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