Vestibular schwannoma extending into the tympanic cavity and jugular fossa by invasion of the petrous bone

2019 ◽  
pp. 1-3
Author(s):  
Hideaki Matsumura ◽  
Masahide Matsuda ◽  
Keiji Tabuchi ◽  
Tetsuya Yamamoto ◽  
Eiichi Ishikawa ◽  
...  
Keyword(s):  
Vestibular Schwannoma ◽  
Petrous Bone ◽  
Tympanic Cavity ◽  
Jugular Fossa

scholarly journals An aberrant venous channel mimicking the perilabyrinthine cells in the petrous bone of a patient with vestibular schwannoma: illustrative case

2021 ◽  
Vol 2 (18) ◽  
Author(s):  
Masato Ito ◽  
Yoshinori Higuchi ◽  
Kentaro Horiguchi ◽  
Shigeki Nakano ◽  
Shinichi Origuchi ◽  
...  
Keyword(s):  
Vestibular Schwannoma ◽  
Internal Auditory Canal ◽  
Posterior Wall ◽  
Anatomical Variations ◽  
Petrous Bone ◽  
Bone Defects ◽  
Jugular Bulb ◽  
Illustrative Case ◽  
Computed Tomographic ◽  
Major Vein

BACKGROUND Anatomical variations, such as high jugular bulbs and air cell development in the petrosal bone, should be evaluated before surgery. Most bone defects in the internal auditory canal (IAC) posterior wall are observed in the perilabyrinthine cells. An aberrant vascular structure passing through the petrous bone is rare. OBSERVATIONS A 48-year-old man presented with a right ear hearing disturbance. Magnetic resonance imaging revealed a 23-mm contrast-enhancing mass in the right cerebellopontine angle extending into the IAC, consistent with a right vestibular schwannoma. Preoperative bone window computed tomographic scans showed bone defects in the IAC posterior wall, which ran farther posteroinferiorly in the petrous bone, reaching the medial part of the jugular bulb. The tumor was accessed via a lateral suboccipital approach. There was no other major vein in the cerebellomedullary cistern, except for the vein running from the brain stem to the IAC posterior wall. To avoid complications due to venous congestion, the authors did not drill out the IAC posterior wall or remove the tumor in the IAC. LESSONS Several aberrant veins in the petrous bone are primitive head sinus remnants. Although rare, their surgical implication is critical in patients with vestibular schwannomas.

scholarly journals Middle Fossa Approach for Resection of an Intracanalicular Vestibular Schwannoma

2019 ◽  
Vol 80 (S 03) ◽  
pp. S287-S287
Author(s):  
Walter C. Jean ◽  
Kyle Mueller ◽  
H. Jeffrey Kim
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Middle Cranial Fossa ◽  
Petrous Bone ◽  
Middle Fossa ◽  
Middle Fossa Approach ◽  
Nerve Preservation ◽  
Greater Superficial Petrosal Nerve ◽  
Cranial Fossa ◽  
Video Case Report

Objective This video was aimed to demonstrate the middle fossa approach for the resection of an intracanalicular vestibular schwannoma. Design Present study is a video case report. Setting The operative video is showing a microsurgical resection. Participant The patient was a 59-year-old man who presented with worsening headache and right-side hearing loss. He was found to have a right intracanalicular vestibular schwannoma. After weighing risks and benefits, he chose surgery to remove his tumor. Since his hearing remained “serviceable,” a middle fossa approach was chosen. Main Outcome Measures Pre- and postoperative patient photographs evaluated the muscles of facial expression as a marker for facial nerve preservation. Results A right middle fossa craniotomy was performed which allowed access to the floor of the middle cranial fossa. The greater superficial petrosal nerve (GSPN) and arcuate eminence were identified. Using these two landmarks, the internal acoustic canal (IAC) was localized. After drilling the petrous bone, the IAC was unroofed. The facial nerve was identified by stimulation and visual inspection and the tumor was separated from it with microsurgical dissection. In the end, the tumor was fully resected. Both the facial and cochlear nerves were preserved. Postoperatively, the patient experienced no facial palsy and his hearing is at baseline. Conclusion With radiosurgery gaining increasing popularity, patients with intracanalicular vestibular schwannomas are frequently treated with it, or are managed with observation. The middle fossa approach is therefore becoming a “lost art,” but as demonstrated in this video, remains an effective technique for tumor removal and nerve preservation.The link to the video can be found at: https://youtu.be/MD6o3DF6jYg.

Influence of phylogeny on jugular fossa shape and otological disorders

1997 ◽  
Vol 111 (11) ◽  
pp. 1027-1033 ◽  
Author(s):  
Atsunobu Tsunoda ◽  
Mari Yamada ◽  
Atsushi Komatsuzaki
Keyword(s):  
Transverse Sinus ◽  
Tympanic Cavity ◽  
Jugular Fossa ◽  
Human Skulls ◽  
The Right

AbstractWe examined the shape of the jugular fossa and its protrusion into the tympanic cavity in 51 human skulls and in 355 various monkey skulls. All human specimens had a dome-shaped fossa, and the right fossa was larger than the left in 60 per cent of the specimens. Fossae protruded into the tympanic cavity in 20 per cent of these specimens.In contrast, none of the monkey specimens had a dome-shaped fossa. Some monkeys had saucershaped jugular fossa; the frequency of such fossa became higher as phylogeny progressed. Furthermore, the jugular fossae in monkeys did not protrude into the tympanic cavity. The shapes of both the jugular fossa and sulcus of the transverse sinus were generally symmetrical.The shape of the jugular fossa and its positional relationship to the tympanic cavity were considered from the viewpoint of the influence of phylogeny and the possible relationship to various otological problems.

Transapical extension in difficult cerebellopontine angle tumours: preliminary report

2003 ◽  
Vol 117 (10) ◽  
pp. 788-792 ◽  
Author(s):  
Mario Sanna ◽  
Manoj Agarwal ◽  
Yogesh Jain ◽  
Alessandra Russo ◽  
Abdel Kader Taibah
Keyword(s):  
Vestibular Schwannoma ◽  
Cerebellopontine Angle ◽  
Cranial Nerves ◽  
Internal Auditory Canal ◽  
Petrous Bone ◽  
Vestibular Schwannomas ◽  
Type I ◽  
Posterior Surface ◽  
Prepontine Cistern ◽  
Anterior Extension

Difficult cerebellopontine angle (CPA) tumours namely large/giant vestibular schwannomas, vestibular schwannomas with a significant anterior extension and meningiomas of the posterior surface of the petrous bone extending anterior to the internal auditory canal (IAC) have always posed a problem for the otoneurosurgeon. Modifications of the enlarged translabyrinthine approach (ETLA) specifically aimed at dealing with these tumours are not reported. The aim of this paper is to introduce the transapical extension of ETLA which involves increased circumferential drilling around the IAC beyond 270°C. The extension allows enhanced surgical control over the tumour as well as the anterior aspect of the CPA including the prepontine cistern, the Vth and VIth cranial nerves. The extension is further classified into Type I and II depending upon the extent of drilling. Type I extension entails drilling around the IAC for 300–320° and is indicated for large/giant vestibular schwannomas (large vestibular schwannoma extrameatal diameter 3–3.9 cm, giant vestibular schwannoma extrameatal diameter [ges ]4 cm) and vestibular schwannomas with significant anterior extension. Type II extension involves complete drilling around the canal for 360° and is indicated for meningiomas of the posterior surface of the petrous bone extending anterior to the IAC.

Fat Implant is Superior to Muscle Implant in Vestibular Schwannoma Surgery for the Prevention of Cerebrospinal Fluid Fistulae

2008 ◽  
Vol 63 (suppl_1) ◽  
pp. ONS38-ONS43 ◽  
Author(s):  
Wolf O. Lüdemann ◽  
Lennart H. Stieglitz ◽  
Venelin Gerganov ◽  
Amir Samii ◽  
Madjid Samii
Keyword(s):  
Cerebrospinal Fluid ◽  
Vestibular Schwannoma ◽  
Inverse Correlation ◽  
Tumor Grade ◽  
Petrous Bone ◽  
Csf Leak ◽  
Fat Tissue ◽  
Csf Leakage ◽  
Cranial Base Surgery ◽  
Air Cells

Abstract Objective: Meticulous sealing of opened air cells in the petrous bone is necessary for the prevention of cerebrospinal fluid (CSF) fistulae after vestibular schwannoma surgery. We performed a retrospective analysis to determine whether muscle or fat tissue is superior for this purpose. Methods: Between January 2001 and December 2006, 420 patients underwent retrosigmoidal microsurgical removal by a standardized procedure. The opened air cells at the inner auditory canal and the mastoid bone were sealed with muscle in 283 patients and with fat tissue in 137 patients. Analysis was performed regarding the incidence of postoperative CSF fistulae and correlation with the patient's sex and tumor grade. Results: The rate of postoperative CSF leak after application of fat tissue was lower (2.2%) than after use of muscle (5.7%). Women had less postoperative CSF leakage (3.4%) than men (5.6%). There was an inverse correlation with tumor grade. Patients with smaller tumors seemed to have a higher rate of CSF leakage than those with large tumors without hydrocephalus. Only large tumors with severe dislocation of the brainstem causing hydrocephalus showed a higher incidence of CSF leaks. Conclusion: Fat implantation is superior to muscle implantation for the prevention of CSF leakage after vestibular schwannoma surgery and should, therefore, be used for the sealing of opened air cells in cranial base surgery.

Petrous Bone Pneumatization Is a Risk Factor for Cerebrospinal Fluid Fistula Following Vestibular Schwannoma Surgery

2010 ◽  
Vol 67 (suppl_2) ◽  
pp. ons509-ons515 ◽  
Author(s):  
Lennart Henning Stieglitz ◽  
Mario Giordano ◽  
Venelin Gerganov ◽  
Andreas Raabe ◽  
Amir Samii ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cell Volume ◽  
Vestibular Schwannoma ◽  
Internal Auditory Canal ◽  
Tumor Grade ◽  
Petrous Bone ◽  
Control Group ◽  
Surgical Removal ◽  
Csf Fistula ◽  
The Mean

ABSTRACT BACKGROUND: For the prevention of postoperative CSF fistula a better understanding of origins and risk factors is necessary. OBJECTIVE: To identify the petrous bone air cell volume as a risk factor for developing CSF fistula, we performed a retrospective analysis. METHODS: From 2000 to 2007 519 patients had a retrosigmoidal surgical removal of a vestibular schwannoma. The 22 who had a postoperative CSF fistula were chosen for evaluation in addition to 78 patients who were randomly selected in 4 equally sized cohorts: male/female with small/large tumors. Preoperative CT scans were analyzed regarding petrous bone air cell volume, area of visible pneumatization at the level of the internal auditory canal (IAC), tumor grade, and sex. RESULTS: Women developed nearly half as many CSF fistulas (2.7%) as men (5.2%). The mean volume of the petrous bone air cells was 10.97 mL (SD, 4.9; range, 1.38-27.25). It was significantly lower for women (mean, 9.23 mL; SD, 3.8) than for men (mean, 12.5 mL; SD, 5.28; P = .0008). The mean air cell volume of CSF-fistula patients was 13.72 mL (SD, 5.22). The difference concerning the air cell volume between patients who developed CSF fistulas and patients from the control group was significant (P = .0042). There was a significant positive correlation between the air cell volume and the area of pneumatization in one CT slide at the level of the IAC. CONCLUSION: The higher incidence of CSF fistulas in men compared with women can be explained by means of differently pneumatized petrous bones. A high amount of petrous bone pneumatization has to be considered as a risk factor for the development of postoperative CSF fistula after vestibular schwannoma surgery.

Surgical anatomy of the hypotympanum

1987 ◽  
Vol 101 (5) ◽  
pp. 419-425 ◽  
Author(s):  
D. SaviČ ◽  
D. Djerič
Keyword(s):  
Internal Carotid ◽  
Outer Wall ◽  
Petrous Bone ◽  
Jugular Bulb ◽  
Surgical Anatomy ◽  
Front Wall ◽  
Tympanic Cavity ◽  
Lower Wall ◽  
Back Wall ◽  
Temporal Bones

AbstractAnatomical characteristics of the hypotympanum were tested on 50 temporal bones. The hypotympanum has the shape of an irregular bony groove which is surrounded by five walls. The outer wall is formed by the tympanic part of the temporal bone. In 65 per cent of the cases the inner wall is formed by part of the petrous bone which extends under the promontory; in 25 per cent it is formed only by the lower part of the promontory; and in 10 per cent it corresponds to the juncture of the promontory and the petrous bone. The lower wall is clearly defined in 48.2 per cent of cases and corresponds to the juncture of its inner and outer walls. In 65 per cent of cases a recess of the inferior hypotympanic sinus is found on the floor of the hypotympanum. In 25.3 per cent of cases the jugular bulb protrudes into the tympanic cavity. In 73.4 per cent of cases the front wall is formed by part of the petrous bone which extends from its floor towards the tympanic opening of the protympanum, and in 26 per cent of the cases it is formed by the wall of the internal carotid artery. On the front wall, in 22.4 per cent of cases, a recess of the anterior hypotympanic sinus is found. The back wall is formed by elements of the styloid complex and in five per cent of the cases a recess or posterior hypotympanic sinus is found on it.

Topographic Changes in Petrous Bone Anatomy in the Presence of a Vestibular Schwannoma and Implications for the Retrosigmoid Transmeatal Approach

2014 ◽  
Vol 10 (3) ◽  
pp. 481-486 ◽  
Author(s):  
Florian H. Ebner ◽  
Maximilian Kleiter ◽  
Sören Danz ◽  
Ulrike Ernemann ◽  
Bernhard Hirt ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Vestibular Schwannoma ◽  
Internal Auditory Canal ◽  
Petrous Bone ◽  
Sigmoid Sinus ◽  
Medial Border ◽  
Vestibular Aqueduct ◽  
Hearing Function ◽  
Before And After ◽  
Risk Pattern

AbstractBACKGROUND:The maneuver of transmeatal drilling carries the risk of injuring inner ear structures, which may cause immediate or delayed hearing loss.OBJECTIVE:To describe the changes in petrous bone anatomy caused by the tumor and to analyze both the incidence and the risk pattern for violation of the endolymphatic system in a surgical series.METHODS:One hundred patients operated on for vestibular schwannoma were included in this prospective study. Thin-slice computed tomography was performed before and after surgery. We assessed topographic measurements on both the pathological and healthy sides. Postoperatively, we evaluated anatomic and functional values.RESULTS:The diameter of the internal auditory canal was significantly larger (P < .001) in the petrous bones of the affected sides than in the contralateral healthy sides. An average of 5.6 ± 1.8 mm of the internal auditory canal was drilled, and the distance from the medial border of the sigmoid sinus to the drilling line (tangential to the drilled surface of the posterior lip of the internal auditory canal) was 9.8 ± 2.9 mm. A postoperative violation of the vestibular aqueduct (VA) was detected in 41 cases; the VA was intact in 55 cases; and the VA could not be clearly defined in 4 cases. The incidence of VA injury increased with increasing tumor size. In the patient group with good preoperative and postoperative hearing function, a VA injury occurred in 26% of cases, whereas the incidence increased to 67% in preoperatively deaf patients.CONCLUSION:Vestibular schwannomas cause significant distortion of the petrous bone anatomy. Detailed preoperative knowledge of the topography is necessary for the preservation of function.

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