Repair of Temporal Bone Defects via the Middle Cranial Fossa Approach: Treatment of 2 Pathologies With 1 Operation

We conducted a study to establish standardized measurements of the common anatomic landmarks used during surgery via the middle cranial fossa approach. Results were based on high-resolution computed tomography (CT) images of 98 temporal bones in 54 consecutively presenting patients. Measurements were obtained with the assistance of the standard PACS (picture archiving and communication system) software. We found that the superior semicircular canal (SSC) dome was not the highest point on the temporal bone (i.e., the arcuate eminence) in 78 of the temporal bone images (79.6%). Pneumatization above the SSC and above the internal auditory canal (IAC) was found in 27 (27.6%) and 39 (39.8%) temporal bone images, respectively. The anterior wall of the external auditory canal was always anterior to the anterior wall of the IAC. The mean angles between the SSC and the posterior and anterior walls of the IAC were 42.3° and 60.8°, respectively. We also measured other distances, and we compared our findings with those published by others. We hope that the results of our study will help surgeons safely and rapidly locate anatomic landmarks when performing surgery via the middle cranial fossa approach.

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Middle cranial fossa approach to repair of temporal bone encephaloceles and CSF leaks with over 18 years experience with future implications on driving regulations in the UK

The Journal of Laryngology & Otology ◽

10.1017/s0022215116003418 ◽

2016 ◽

Vol 130 (S3) ◽

pp. S83-S83

Author(s):

Jeyanthi Kulasegarah ◽

Emma Hoskison ◽

Karam Narang ◽

Scott Mitchell ◽

Richard Irving

Keyword(s):

Temporal Bone ◽

Middle Cranial Fossa ◽

Middle Cranial Fossa Approach ◽

Cranial Fossa ◽

The Uk ◽

Csf Leaks

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The enlarged middle cranial fossa approach for surgery of the temporal bone and of the cerebellopontine angle

Archives of Oto-Rhino-Laryngology ◽

10.1007/bf00463580 ◽

1989 ◽

Vol 246 (5) ◽

pp. 299-302 ◽

Cited By ~ 33

Author(s):

M. E. Wigand ◽

T. Haid ◽

M. Berg

Keyword(s):

Temporal Bone ◽

Cerebellopontine Angle ◽

Middle Cranial Fossa ◽

Middle Cranial Fossa Approach ◽

Cranial Fossa

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Surgical treatment of patients with defects of middle cranial fossa complicated by meningoencephalic hernia with various ear pathology

Russian otorhinolaryngology ◽

10.18692/1810-4800-2021-5-25-39 ◽

2021 ◽

Vol 20 (5) ◽

pp. 25-39

Author(s):

Kh. M. Diab ◽

◽

V. S. Korvyakov ◽

A. E. Mikhalevich ◽

O. A. Pashchinina ◽

...

Keyword(s):

Surgical Treatment ◽

Temporal Bone ◽

High Efficiency ◽

Middle Cranial Fossa ◽

Disease Recurrence ◽

Bone Defects ◽

Performance Criteria ◽

Results Of Treatment ◽

Hernia Formation ◽

Cranial Fossa

Surgical treatment of patients with defects of the middle cranial fossa complicated by meningoencephalic herniation, with various ear pathologies, is an important problematic issue at the intersection of two disciplines – otorhinolaryngology and neurosurgery. The issues of etiology and pathogenesis of bone formation in defects of the middle cranial fossa and the methods of surgical treatment of patients with bone defects of the middle cranial fossa complicated by meningoencephalic herniation of the temporal bone. The analysis of the causes of recurrence of the disease with the use of certain techniques was carried out, and based on this, an improved technique for multilayer plastics of a bone defect of the middle cranial fossa through a combined approach (behind the ear (BTE) transmastoid + infratemporal minicraniotomy) using autotissues, biocomposite materials, and adhesive components was developed and described. Evaluated performance criteria for all treated patients were: absence of recurrence of hernia formation of shells and substances of the brain in the middle ear cavity and the absence of otorrhea. All the operated patients with defects of the middle cranial fossa and meningoencephalocele of the temporal bone were followed up from 1 to 5 years. Preliminary analysis of the results of treatment of patients using the improved method showed its high efficiency, which is confirmed by the absence of disease recurrence. On this basis, the main conclusions are formulated and a brief algorithm of surgical tactics for the closure of bone defects of the middle cranial fossa of various sizes is presented.

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Middle Cranial Fossa Approach: The Incudomalleolar Joint as a Reliable Landmark

International Archives of Otorhinolaryngology ◽

10.1055/s-0040-1712105 ◽

2020 ◽

Author(s):

Syed Salman Hashmi ◽

Juan Carlos Izquierdo ◽

Susan D. Emmett ◽

Thomas Edwin Linder

Keyword(s):

Temporal Bone ◽

Surgical Approach ◽

Semicircular Canal ◽

Middle Cranial Fossa ◽

Middle Cranial Fossa Approach ◽

Virtual Line ◽

Close Relationship ◽

Cranial Fossa ◽

The Mean ◽

Blue Line

Abstract Introduction The middle cranial fossa approach is performed by fewer neurotologists owing to a reduced number of indications. Consistent landmarks are mandatory to guide the surgeon in a narrow field. Objectives We have evaluated the incus and malleus head and the incudomalleal joint (IMJ) as a key landmark for identifying the superior semicircular canal (SSC) and to get oriented along the floor of the middle cranial fossa. Methods A combination of 20 temporal bone dissections and CT imaging were utilized to test and describe these landmarks. Results The blue line of the SSC is consistently identified along the prolongation of a virtual line through the IMJ and the angulation toward the root of zygoma. The mean distance from the zygoma toward the IMJ ranged from 1.60 to 1.90cm. Once the IMJ was identified, the blue line of the SSC was consistently found along the virtual line through the IMJ within 5 to 9mm. Conclusions The IMJ is a safe and consistent anatomical marker in the surgical approach to the middle cranial fossa floor. Opening the tegmen 1.5 to 2cm medial to the root of the zygoma and identifying the joint allows to trace a virtual line toward the SSC within 5 to 9mm. Knowledge of the close relationship between the direction of the IMJ and the superior canal can be used in all transtemporal approaches, thus orienting the surgeon in a rather narrow field with limited retraction of the dura and brain.

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Middle cranial fossa approach to repair tegmen defects assisted by three-dimensionally printed temporal bone models

The Laryngoscope ◽

10.1002/lary.26438 ◽

2016 ◽

Vol 127 (10) ◽

pp. 2347-2351 ◽

Cited By ~ 7

Author(s):

Sameer Ahmed ◽

Kyle K. VanKoevering ◽

Stephanie Kline ◽

Glenn E. Green ◽

H. Alexander Arts

Keyword(s):

Temporal Bone ◽

Middle Cranial Fossa ◽

Middle Cranial Fossa Approach ◽

Cranial Fossa

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The rationale for conducting a scientific study on the choice of surgical treatment tactics for patients with temporal bone defects localized in the projection of the middle cranial fossa – the roof of the attic and(or) antrum

Russian otorhinolaryngology ◽

10.18692/1810-4800-2020-4-74-81 ◽

2020 ◽

Vol 19 (4) ◽

pp. 74-81

Author(s):

Kh. M. Diab ◽

◽

V. S. Korvyakov ◽

O. A. Pashchinina ◽

B. S. Khasan ◽

...

Keyword(s):

Surgical Treatment ◽

Temporal Bone ◽

Bone Defect ◽

Middle Cranial Fossa ◽

Bone Defects ◽

Scientific Study ◽

Review Of Literature ◽

Free Surfaces ◽

Plastic Materials ◽

Cranial Fossa

The article on the basis of a review of literature presents the justification for the possibility of conducting a scientific study on the choice of surgical treatment tactics of patients with temporal bone defects, localized in the projection of the middle cranial hole. When choosing a method of surgical treatment, the main importance will be given not only to the localization, number and size of bone defect, but also to experimentally established features inherent in cranioplasty, which are associated with nature the graft used, its installation and fixation in the bone bed, as well as the shelter of its free surfaces with additional plastic materials.

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