Anatomical considerations of high jugular bulb in lateral skull base surgery

1997 ◽  
Vol 111 (4) ◽  
pp. 333-336 ◽  
Author(s):  
Asim Aslan ◽  
Maurizio Falcioni ◽  
Alessandra Russo ◽  
Giuseppe De Donato ◽  
Fatih Ridvan Balyan ◽  
...  
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Cranial Nerves ◽  
Internal Auditory Canal ◽  
Jugular Bulb ◽  
Mastoid Process ◽  
High Jugular Bulb ◽  
Lateral Skull Base ◽  
Significant Difference ◽  
Temporal Bones

AbstractIn order to study high jugular bulb management in lateral skull base surgery, an anatomical study was conducted on 30 temporal bones by examining the relationship between the internal auditory canal (IAC) and the jugular bulb. The following parameters were measured: 1) Height of the jugular bulb (H) … distance between the level of the jugular bulb dome and the line passing through the confluence of the sigmoid sinus with the jugular bulb (SS-JB), 2) Mastoid length (ML) … distance between the mastoid process and middle cranial fossa dura, 3) Distance between the most inferior part of the porus acousticus and jugular bulb dome (A), 4) Distance between the porus acousticus and SS-JB (B). The jugular bulb was defined as high when it occupied more than two thirds of (B). The incidence of a high jugular bulb was 23 per cent in this study. When the jugular bulb was high, the mean (H) and (A) were 9.4 ± 1.9 mm and 2.7 ± 0.5 mm, respectively. (H) was higher on the right side than on the left side. No statistically significant difference was found between small and large mastoids (t-test: p>0.05). It was concluded that when a high jugular bulb was encountered during lateral skull base surgery, the jugular bulb position allows a very small working area inferior to the IAC. In these cases, a 3 or 4 mm depression of the jugular bulb is necessary in order to expose the lower cranial nerves. This can be accomplished by lowering the jugular bulb with the technique already described.

The cochlear aqueduct: An important landmark in lateral skull base surgery

1998 ◽  
Vol 118 (4) ◽  
pp. 532-536
Author(s):  
Asim Aslan ◽  
Maurizio Falcioni ◽  
Fatih Ridvan Balyan ◽  
Giuseppe De Donato ◽  
Abdelkader Taibah ◽  
...  
Keyword(s):  
Skull Base ◽  
Sagittal Plane ◽  
Skull Base Surgery ◽  
Cranial Nerves ◽  
Close Relation ◽  
Cochlear Aqueduct ◽  
Lateral Skull Base ◽  
Important Landmark ◽  
Temporal Bones ◽  
Relationship Of

The cochlear aqueduct (CA) is used as a landmark in lateral skull base surgery. In this study anatomic relationships between the CA and adjacent neurovascular structures were examined by dissecting 32 temporal bones. Observations of the relationship of the external opening (EO) of the CA with the ninth, tenth, and eleventh cranial nerves, inferior petrosal sinus (IPS), and intrapetrous carotid artery (ICA) were noted. In addition to the distance of the EO of the CA to the vertical portion of the ICA, the entire length of the CA and the width of the EO were also measured. The ninth nerve was the only structure lodged at the EO of the CA in 34.4% of bones. However, in 40.6% of bones only the IPS crossed the EO of the CA, although the ninth nerve was situated just anteroinferiorly in the vicinity of the EO. In 15.6% of bones it was possible to observe both the ninth nerve and the IPS crossing the EO. In 9.4% of bones the EO of the CA was found to be occupied by the tenth and eleventh nerves. It was also observed that the ICA was located anteriorly on the same sagittal plane with the EO in 15.6% of bones. It was concluded that although in 90% of cases the EO of the CA was in close relation with the ninth nerve, other structures such as the IPS, the tenth and eleventh cranial nerves, and the ICA were also at risk during drilling in this area because of their intimate relationships with the EO of the CA.

scholarly journals Audit of Complications in an Otolaryngology Led Skull-Base Surgical Practice

2018 ◽  
Vol 80 (06) ◽  
pp. 586-592
Author(s):  
Uma Patnaik ◽  
Smriti Panda ◽  
Alok Thakar
Keyword(s):  
Skull Base ◽  
Surgical Complications ◽  
Skull Base Surgery ◽  
Major Complication ◽  
Anterior Skull Base ◽  
Complication Rates ◽  
Permanent Disability ◽  
Lateral Skull Base ◽  
Significant Difference ◽  
Surgical Complexity

Objective This study was aimed to classify and study complications of surgery of the cranial base, primarily from an otorhinolaryngology perspective. Design This study was designed with consecutive cohort of skull base surgical cases. Setting Tertiary referral academic center. Participants Patients having skull-base surgery at a otorhinolaryngology based skull-base unit, from 2002 to 2015. Main Outcome Measures Enumeration of complications is the main outcome of this study. Surgical procedures, categorized for complexity as per a unified system, are applicable to endoscopic and open procedures. Complications were categorized as per the British Association of Otolaryngologists coding of surgical complications. Complication classified as major if life-threatening, causing permanent disability, or compromising the result of surgery. Results A total of 342 patients (n = 342) were operated; 13 patients' records were excluded due to < 6 months posttreatment follow-up. The study group constituted 204 anterior skull-base (endoscopic, 120; open/external, 84) and 125 lateral skull-base procedures. Complication rates noted to increase in both groups with increasing complexity of surgical intervention. Anterior skull-base surgery (total complications, 11%; major, 3%; death, 0.5%) noted to have significantly less surgical complications than lateral skull-base surgery (total complications, 33%; major, 15%; death, 1.6%; p < 0.001). Among the anterior procedures no significant difference noted among endoscopic and external approaches when compared across similar surgical complexity. Conclusion Despite improvement in surgical and perioperative care, the overall major complication rate in a contemporary otolaryngology led, primarily extradural, skull-base practice is noted at 8%. Perioperative mortality, though rare, was encountered in 1%. A standard method for categorization of surgical complexity and the grade of complications as reported here is recommended.

Transcanal Computed Tomography Views for Transcanal Endoscopic Lateral Skull Base Surgery: Pilot Cadaveric Study

2019 ◽  
Author(s):  
Rory J. Lubner ◽  
Samuel R. Barber ◽  
Renata M. Knoll ◽  
Judith Kempfle ◽  
Daniel J. Lee ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Skull Base ◽  
Skull Base Surgery ◽  
Imaging Study ◽  
Preoperative Imaging ◽  
Slice Thickness ◽  
Imaging Evaluation ◽  
Mean Values ◽  
Lateral Skull Base ◽  
Temporal Bones

Abstract Objectives Transcanal endoscopic operative approaches provide for a minimally invasive surgical portal to the lateral skull base. Traditional preoperative imaging evaluation involves computed tomography (CT) acquisition in the axial and coronal planes that are not optimized for the transcanal surgical corridor. Herein, we describe a novel CT-based “transcanal view” for preoperative surgical planning and intraoperative navigation. Study Design Present study is a cadaveric imaging study. Methods Cadaveric temporal bones (n = 6) from three specimens underwent high-resolution CT (0.625 mm slice thickness). Using three-dimensional (3D) Slicer 4.8, reformatted “transcanal” views in the plane of the external auditory canal (EAC) were created. Axial and coronal reformats were used to compare and measure distances between anatomic structures in the plane of the EAC. Results The degree of oblique tilt for transcanal CT reformats was 6.67 ± 1.78 degrees to align the EAC in axial and coronal planes. Anticipated critical landmarks were identified easily using the transcanal view. Mean values were 8.68 ± 0.38 mm for annulus diameter, 9.5 ± 0.93 mm for isthmus diameter, 10.27 ± 0.73 mm for distance between annulus and isthmus, 2.95 ± 0.13 mm for distance between annulus and stapes capitulum, 5.12 ± 0.35 mm for distance between annulus and mastoid facial nerve, and 19.54 ± 1.22 mm for EAC length. Conclusions This study is the first to illustrate a novel “transcanal” CT sequence intended for endoscopic lateral skull base surgery. Future studies may address how incorporation of a transcanal CT reformat may influence surgical decision making.

scholarly journals Management of the Jugular Bulb During Lateral Skull Base Surgery

Skull Base ◽  
1994 ◽  
Vol 4 (01) ◽  
pp. 37-40
Author(s):  
Timothy F. Kelley ◽  
John P. Leonetti ◽  
David J. Newell ◽  
William J. Remington
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Jugular Bulb ◽  
Lateral Skull Base

Increasing Safety in Lateral Skull Base Surgery by Navigation

Skull Base ◽  
2007 ◽  
Vol 17 (S 1) ◽  
Author(s):  
Rainer Schmelzeisen ◽  
Marc Metzger
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Lateral Skull Base

Full tractography for detecting the position of cranial nerves in preoperative planning for skull base surgery: technical note

2020 ◽  
Vol 132 (5) ◽  
pp. 1642-1652 ◽  
Author(s):  
Timothee Jacquesson ◽  
Fang-Chang Yeh ◽  
Sandip Panesar ◽  
Jessica Barrios ◽  
Arnaud Attyé ◽  
...  
Keyword(s):  
Skull Base ◽  
Preoperative Planning ◽  
Skull Base Surgery ◽  
Cranial Nerves ◽  
Patient Specific ◽  
Small Scale ◽  
Skull Base Tumor ◽  
Skull Base Tumors ◽  
Brain White Matter ◽  
Human Connectome Project

OBJECTIVEDiffusion imaging tractography has allowed the in vivo description of brain white matter. One of its applications is preoperative planning for brain tumor resection. Due to a limited spatial and angular resolution, it is difficult for fiber tracking to delineate fiber crossing areas and small-scale structures, in particular brainstem tracts and cranial nerves. New methods are being developed but these involve extensive multistep tractography pipelines including the patient-specific design of multiple regions of interest (ROIs). The authors propose a new practical full tractography method that could be implemented in routine presurgical planning for skull base surgery.METHODSA Philips MRI machine provided diffusion-weighted and anatomical sequences for 2 healthy volunteers and 2 skull base tumor patients. Tractography of the full brainstem, the cerebellum, and cranial nerves was performed using the software DSI Studio, generalized-q-sampling reconstruction, orientation distribution function (ODF) of fibers, and a quantitative anisotropy–based generalized deterministic algorithm. No ROI or extensive manual filtering of spurious fibers was used. Tractography rendering was displayed in a tridimensional space with directional color code. This approach was also tested on diffusion data from the Human Connectome Project (HCP) database.RESULTSThe brainstem, the cerebellum, and the cisternal segments of most cranial nerves were depicted in all participants. In cases of skull base tumors, the tridimensional rendering permitted the visualization of the whole anatomical environment and cranial nerve displacement, thus helping the surgical strategy.CONCLUSIONSAs opposed to classical ROI-based methods, this novel full tractography approach could enable routine enhanced surgical planning or brain imaging for skull base tumors.

scholarly journals Levels of Evidence in Rhinology and Skull Base Surgery Research

2021 ◽  
pp. 019459982098713
Author(s):  
Jennifer A. Silver ◽  
Marco Mascarella ◽  
George Tali ◽  
Rickul Varshney ◽  
Marc A. Tewfik ◽  
...  
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Absolute Number ◽  
High Quality ◽  
Level Of Evidence ◽  
Levels Of Evidence ◽  
The Past ◽  
Significant Difference ◽  
Surgery Research ◽  
Based Medicine

Objective The purpose of this study was to evaluate the quality of evidence of rhinology and rhinologic skull base surgery (RSBS) research and its evolution over the past decade. Study Design Review article. Setting We reviewed articles from 2007 to 2019 in 4 leading peer-reviewed otolaryngology journals and 3 rhinology-specific journals. Methods The articles were reviewed and levels of evidence were assigned using the Oxford Centre for Evidence-Based Medicine 2011 guidelines. High quality was defined as level of evidence 1 or 2. Results In total, 1835 articles were reviewed in this study spanning a 13-year period. Overall, the absolute number of RSBS publications increased significantly 22.6% per year, from 108 articles in 2007 to 481 in 2019 ( P < .001; 95% CI, 7.9-37.2). In 2007, only 13 articles, or 15%, were high quality, and this grew to 146 articles, or 39%, in 2019. A 14.0% per year exponential increase in the number of high-quality publications was found to be statistically significant ( P < .001; 95% CI, 7.2, 20.7). Overall, high-quality publications represented just 25.8% of RSBS articles overall. There was no significant difference in quality between rhinology-specific journals and general otolaryngology journals (χ2 = 3.1, P = .077). Conclusion The number of overall publications and of high-quality RSBS publications has significantly increased over the past decade. However, the proportion of high-quality studies continues to represent a minority of total RSBS research.

Multi-Disciplinary Skull Base Conference and its Effects on Patient Management

2021 ◽  
pp. 000348942110212
Author(s):  
Nathan Kemper ◽  
Scott B. Shapiro ◽  
Allie Mains ◽  
Noga Lipschitz ◽  
Joseph Breen ◽  
...  
Keyword(s):  
Skull Base ◽  
Medical Center ◽  
Academic Medical Center ◽  
Significant Proportion ◽  
Internal Auditory Canal ◽  
Patient Characteristics ◽  
Management Plan ◽  
Case Review ◽  
Retrospective Case ◽  
Lateral Skull Base

Objective: Examine the effects of a multi-disciplinary skull base conference (MDSBC) on the management of patients seen for skull base pathology in a neurotology clinic. Methods: Retrospective case review of patients who were seen in a neurotology clinic at a tertiary academic medical center for pathology of the lateral skull base and were discussed at an MDSBC between July 2019 and February 2020. Patient characteristics, nature of the skull base pathology, and pre- and post-MDSBC plan of care was categorized. Results: A total of 82 patients with pathology of the lateral skull base were discussed at a MDSBC during an 8-month study period. About 54 (65.9%) had a mass in the internal auditory canal and/or cerebellopontine angle while 28 (34.1%) had other pathology of the lateral skull base. Forty-nine (59.8%) were new patients and 33 (40.2%) were established. The management plan changed in 11 (13.4%, 7.4-22.6 95% CI) patients as a result of the skull base conference discussion. The planned management changed from some form of treatment to observation in 4 patients, and changed from observation to some form of treatment in 4 patients. For 3 patients who underwent surgery, the planned approach was altered. Conclusions: For a significant proportion of patients with pathology of the lateral skull base, the management plan changed as a result of discussion at an MDSBC. Although participants of a MDSBC would agree of its importance, it is unclear how an MDSBC affects patient outcomes.

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