Middle Fossa Approach For Acoustic Tumor Removal

1992 ◽  
Vol 25 (2) ◽  
pp. 347-359 ◽  
Author(s):  
William F. House ◽  
Clough Shelton
Keyword(s):  
Middle Fossa ◽  
Tumor Removal ◽  
Middle Fossa Approach ◽  
Acoustic Tumor

Complications of Translabyrinthine Vs. Suboccipital Approach for Acoustic Tumor Surgery

1988 ◽  
Vol 99 (4) ◽  
pp. 396-400 ◽  
Author(s):  
Charles A. Mangham
Keyword(s):  
Exploratory Analysis ◽  
The Other ◽  
Tumor Surgery ◽  
Middle Fossa ◽  
Tumor Removal ◽  
Two Stage ◽  
Operative Results ◽  
Middle Fossa Approach ◽  
Acoustic Tumor ◽  
Suboccipital Approach

This study presents the operative results of surgeons with experience in both the translabyrinthine and suboccipital approaches to acoustic tumor removal for the purpose of resolving some of the controversy among centers favoring one approach over the other. The subjects were 171 patients with acoustic tumors who were treated at Virginia Mason Clinic from 1975 to 1986. The translabyrinthine approach was used in 64% of cases, the suboccipital approach in 35%, and the middle fossa approach in 1%. There were minor differences in morbidity and mortality between approaches. These data did not favor one approach over another. In an exploratory analysis, we found that the morbidity with a planned two-stage translabyrinthine-suboccipital removal was greater than the morbidity with a one-stage removal.

Middle Fossa Approach for Acoustic Tumor Removal

2008 ◽  
Vol 19 (2) ◽  
pp. 279-288 ◽  
Author(s):  
William F. House ◽  
Clough Shelton
Keyword(s):  
Middle Fossa ◽  
Tumor Removal ◽  
Middle Fossa Approach ◽  
Acoustic Tumor

Auditory-Nerve Integrity after Middle-Fossa Acoustic-Tumor Removal

1998 ◽  
Vol 119 (6) ◽  
pp. 588-592 ◽  
Author(s):  
Rick A. Friedman ◽  
Derald E. Brackmann ◽  
Dawna Mills
Keyword(s):  
Auditory Nerve ◽  
Middle Fossa ◽  
Tumor Removal ◽  
Acoustic Tumor

Middle Fossa Approach for Facial Nerve Schwannoma Aiming for Functional Improvement: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (5) ◽  
pp. E167-E168
Author(s):  
Ken Matsushima ◽  
Michihiro Kohno ◽  
Hitoshi Izawa ◽  
Yujiro Tanaka
Keyword(s):  
Facial Nerve ◽  
Facial Palsy ◽  
Tumor Resection ◽  
Nerve Fibers ◽  
Middle Fossa ◽  
Tumor Removal ◽  
Middle Fossa Approach ◽  
Brainstem Response ◽  
Facial Nerve Schwannoma

Abstract The treatment paradigm of skull base surgery has been changed from radical tumor resection to maximal tumor removal while giving priority to functional preservation. Facial nerve schwannoma is one of the representative disorders of this type of paradigm shift.1 This video demonstrates facial nerve schwannoma surgery through the middle fossa approach, aiming for improvement of facial function. A 33-yr-old woman presented with gradually worsening facial palsy (House-Brackmann grade IV), dizziness, and nausea. Neuroimaging revealed a growing tumor involving the geniculate ganglion, and extending to the middle fossa, internal acoustic meatus, and cerebellopontine angle. The nerve-sparing surgery through the left middle fossa approach was performed under detailed neuromonitoring including the evoked facial electromyograms and auditory brainstem response. The facial nerve fibers were involved within the tumor mass and the plane between the tumor and facial nerve could not be identified as seen in most cases of such large facial nerve schwannomas. But sufficient tumor removal with facial nerve preservation was achieved owing to continuous facial monitoring.2 The patient had no new neurological deficits. Her facial palsy has been gradually improving, now at grade III, without any signs of tumor regrowth during the 10 mo of follow up after the operation. Careful follow up is being continued to survey the possible tumor recurrence. The video was reproduced after informed consent of the patient.

Management of Cerebrospinal Fluid Leaks After Acoustic Tumor Removal

2007 ◽  
Vol 61 (suppl_3) ◽  
pp. ONS-35-ONS-40 ◽  
Author(s):  
Rick A. Friedman ◽  
Robert D. Cullen ◽  
Jeffrey Ulis ◽  
Derald E. Brackmann
Keyword(s):  
Cerebrospinal Fluid ◽  
Eustachian Tube ◽  
Csf Leak ◽  
Surgical Removal ◽  
Middle Fossa ◽  
Tumor Removal ◽  
Csf Rhinorrhea ◽  
Lumbar Drain ◽  
Hearing Status ◽  
Acoustic Tumor

Abstract Objective: To present a logical algorithm for management of postoperative cerebrospinal fluid (CSF) leak that occurs after acoustic tumor removal, and to describe a method for eustachian tube resection. Clinical Presentation: We present an algorithm in the form of a flow chart, describe middle fossa craniotomy for eustachian tube resection, and present three cases in which this technique was used. Technique: For CSF leak, pressure dressing at the wound and bed rest for the patient are advised; lumbar drain is indicated if the leak does not resolve. Occasionally, wound exploration is required. CSF rhinorrhea is treated first with a lumbar drain. If this approach is unsuccessful, the choice of treatment depends on the patient's hearing status. If a patient has no hearing, we perform a blind sac closure of the ear canal and pack the eustachian tube. If a patient has hearing, wound reexploration and lumbar drainage are advised. When conservative and initial surgical procedures for resolving CSF leak fail, we perform a middle fossa craniotomy to identify, divide, and remove a segmental portion of the cartilaginous eustachian tube and then cauterize and occlude both ends. Conclusion: At centers where surgical removal of acoustic tumors is frequently performed, a logical protocol should be in place for treatment of postoperative CSF leak. The leak location and the patient's hearing status are factors in determining the appropriate treatment method. Middle fossa craniotomy for resection of the eustachian tube is a safe, definitive management option for treatment of recalcitrant CSF rhinorrhea that occurs after acoustic tumor surgery.

Translabyrinthine Approach For Acoustic Tumor Removal

1992 ◽  
Vol 25 (2) ◽  
pp. 311-329
Author(s):  
Deraid E. Brackmann ◽  
J. Douglas Green
Keyword(s):  
Tumor Removal ◽  
Translabyrinthine Approach ◽  
Acoustic Tumor

Complications of Middle Fossa Approach

Skull Base ◽  
2005 ◽  
Vol 15 (S 2) ◽  
Author(s):  
Emilio García-Ibánez ◽  
Luis García-Ibánez ◽  
Elena Hernández ◽  
G. Martínez-Monche
Keyword(s):  
Middle Fossa ◽  
Middle Fossa Approach

Cadaveric Study to Find a Novel Method of Identifying the Internal Acoustic Canal in the Middle Fossa Approach: The Rule of 2s

Skull Base ◽  
2009 ◽  
Vol 19 (03) ◽  
Author(s):  
Raghuram Sampath ◽  
Chad Glenn ◽  
Shashikant Patil ◽  
Prasad Vannemreddy ◽  
Anil Nanda ◽  
...  
Keyword(s):  
Cadaveric Study ◽  
Middle Fossa ◽  
Middle Fossa Approach ◽  
Novel Method ◽  
Internal Acoustic Canal

Endoscopic Endonasal Interdural Middle Fossa Approach to the Maxillary Nerve: Anatomic Considerations and Surgical Relevance

2017 ◽  
Vol 13 (4) ◽  
pp. 522-528 ◽  
Author(s):  
Kumar Abhinav ◽  
David Panczykowski ◽  
Wei-Hsin Wang ◽  
Carl H. Synderman ◽  
Paul A. Gardner ◽  
...  
Keyword(s):  
Average Length ◽  
Tumor Resection ◽  
Human Head ◽  
Proximal Part ◽  
Gasserian Ganglion ◽  
Middle Fossa ◽  
Perineural Spread ◽  
Endoscopic Endonasal ◽  
Middle Fossa Approach ◽  
Maxillary Nerve

Abstract BACKGROUND: The maxillary nerve (V2) can be approached via the open middle fossa approach. OBJECTIVE: To delineate the anatomy of V2 and its specific segments with respect to the endonasal landmarks. We present the endoscopic endonasal interdural middle fossa approach to V2 and its potential application for the treatment of perineural spread in sinonasal/skull base tumors. METHODS: Five human head silicon-injected specimens underwent bilateral endoscopic endonasal transpterygoid approaches. V2 prominence and the maxillary strut were identified in the lateral recess along with paraclival carotid protruberance. The regions superior and inferior to V2 corresponding to the anteromedial and anterolateral triangles of the middle fossa were exposed. RESULTS: V2 can be classified into 3 segments: interdural (from the Gasserian ganglion to the proximal part of the maxillary strut), intracanalicular (corresponding to the anteroposterior length of the maxillary strut), and pterygopalatine (distal to the maxillary strut and the site of its divisions). Endonasally, the average length of the interdural and the intracanalicular segments were approximately 9 and 4.4 mm, respectively. V2, following its division distal to the maxillary strut, was successfully dissected off the middle fossa dura and transected just distal to the Gasserian ganglion. CONCLUSION: Endonasally, the interdural segment can be safely mobilized between the periosteal and meningeal dural layers while ensuring the integrity of the middle fossa dura. This allows transection of infiltrated V2 to facilitate tumor resection without entering the intradural/arachnoidal space. Posteriorly, this is limited by the Gasserian ganglion and superomedially by the dural envelope surrounding the cavernous sinus and the paraclival carotid artery.

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