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

scholarly journals A Novel Method of Identifying the Internal Acoustic Canal in the Middle Fossa Approach in a Cadaveric Study—The Rule of 2s

2012 ◽  
Vol 73 (04) ◽  
pp. 253-260 ◽  
Author(s):  
Raghuram Sampath ◽  
Chad Glenn ◽  
Shashikant Patil ◽  
Prasad Vannemreddy ◽  
Lawrence Gardner ◽  
...  
Keyword(s):  
Cadaveric Study ◽  
Middle Fossa ◽  
Middle Fossa Approach ◽  
Novel Method ◽  
Internal Acoustic Canal

scholarly journals A Rapid and Safe Middle Fossa Approach to the Geniculate Ganglion and Labyrinthine Segment of the Facial Nerve

2002 ◽  
Vol 81 (5) ◽  
pp. 320-326 ◽  
Author(s):  
Ricardo Ferreira Bento ◽  
Rubens Vuono de Brito ◽  
Tanit Ganz Sanchez
Keyword(s):  
Facial Nerve ◽  
Geniculate Ganglion ◽  
Middle Fossa ◽  
Cochlear Function ◽  
Surgical Time ◽  
Anatomic Landmarks ◽  
Middle Fossa Approach ◽  
Surgical Access ◽  
Safe Technique ◽  
Internal Acoustic Canal

The middle fossa approach provides neurotologic surgical access to lesions of the geniculate ganglion and the labyrinthine portion of the facial nerve as well as to the internal acoustic canal, and therefore helps preserve cochlear function. Although this approach is widely used, surgeons are still not certain which anatomic landmarks are best to locate the facial nerve and internal acoustic canal without causing labyrinthine damage. The purpose of this article is to describe a fast and safe technique to expose the geniculate ganglion and the labyrinthine portion of the facial nerve in two structures of the middle ear: the cochleariform process and the tympanic portion of the facial nerve. We prospectively evaluated 32 patients who underwent surgical facial nerve exploration via the middle fossa approach. Our goal was to determine the incidence of intraoperative difficulties and complications; we found none, and hearing levels could not be maintained in only one of the 32 patients. Our technique allowed us to decompress the first genu and the labyrinthine segment of the nerve. It also allowed us to reach and manipulate its tympanic segment in a very short amount of surgical time.

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 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

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.

scholarly journals Resection of a Dumbbell-Shaped Facial Nerve Schwannoma With Preservation of Facial Nerve Function Through the Extended Middle Fossa Approach: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Kaith K Almefty ◽  
Wenya Linda Bi ◽  
Walid Ibn Essayed ◽  
Ossama Al-Mefty
Keyword(s):  
Facial Nerve ◽  
Cerebellopontine Angle ◽  
Internal Auditory Canal ◽  
Growth Patterns ◽  
Geniculate Ganglion ◽  
Nerve Function ◽  
Middle Fossa ◽  
Facial Nerve Function ◽  
Large Tumor ◽  
Middle Fossa Approach

Abstract Facial nerve schwannomas are rare and can arise from any segment along the course of the facial nerve.1 Their location and growth patterns present as distinct groups that warrant specific surgical management and approaches.2 The management challenge arises when the facial nerve maintains good function (House-Brackmann grade I-II).3 Hence, a prime goal of management is to maintain good facial animation. In large tumors, however, resection with facial nerve function preservation should be sought and is achievable.4,5  While tumors originating from the geniculate ganglion grow extradural on the floor of the middle fossa, they may extend via an isthmus through the internal auditory canal to the cerebellopontine angle forming a dumbbell-shaped tumor. Despite the large size, they may present with good facial nerve function. These tumors may be resected through an extended middle fossa approach with preservation of facial and vestibulocochlear nerve function.  The patient is a 62-yr-old man who presented with mixed sensorineural and conductive hearing loss and normal facial nerve function. Magnetic resonance imaging (MRI) revealed a large tumor involving the middle fossa, internal auditory meatus, and cerebellopontine angle.  The tumor was resected through an extended middle fossa approach with a zygomatic osteotomy and anterior petrosectomy.6 A small residual was left at the geniculate ganglion to preserve facial function. The patient did well with hearing preservation and intact facial nerve function. He consented to the procedure and publication of images.  Image at 1:30 © Ossama Al-Mefty, used with permission. Images at 2:03 reprinted from Kadri and Al-Mefty,6 with permission from JNSPG.

scholarly journals A Method of Locating the Dehiscence during Middle Fossa Approach for Superior Semicircular Canal Dehiscence Surgery

2017 ◽  
Vol 78 (S 01) ◽  
pp. S1-S156
Author(s):  
Lawrance Chung ◽  
Joel Beckett ◽  
Carlito Lagman ◽  
Seung Lee ◽  
Timothy Bui ◽  
...  
Keyword(s):  
Semicircular Canal ◽  
Middle Fossa ◽  
Superior Semicircular Canal Dehiscence ◽  
Middle Fossa Approach ◽  
Superior Semicircular Canal ◽  
Canal Dehiscence

The Middle Fossa Approach in the Treatment of Petrositis

1973 ◽  
Vol 98 (6) ◽  
pp. 426-427 ◽  
Author(s):  
E. L. Hendershot ◽  
J. W. Wood
Keyword(s):  
Middle Fossa ◽  
Middle Fossa Approach
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