Anatomic Considerations of the Medial Cuts in the Subtotal Temporal Bone Resection

1982 ◽  
Vol 90 (5) ◽  
pp. 641-645 ◽  
Author(s):  
J. Gail Neely ◽  
Michael Forrester
Keyword(s):  
Temporal Bone ◽  
Cranial Nerves ◽  
Internal Auditory Canal ◽  
Lateral Wall ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Bone Resection ◽  
En Bloc ◽  
Temporal Bone Resection ◽  
Temporal Bones

Eighteen temporal bones, 20 sets of polytomograms, and two sets of histologically sectioned temporal bones were studied and the literature was reviewed in order to describe the evolution and anatomic detail of the medial limits of the subtotal temporal bone resection used when malignant neoplasia has invaded the middle ear. An en bloc resection requires incisions medial to the pneumatized spaces involved. The anatomy of the lines of resection through the glenoid fossa, medial to the lateral wall of the carotid canal, through the cochlea, internal auditory canal, and jugular bulb, and just lateral to cranial nerves IX, X, and XI was described in detail. Regardless of the techniques employed, or the feasibility of the task, the concept of en bloc resection must conform to the anatomy of the region.

Total Temporal Bone Resection for Squamous Cell Carcinoma

1987 ◽  
Vol 96 (1) ◽  
pp. 4-14 ◽  
Author(s):  
Robert Thayer Sataloff ◽  
Donald L. Myers ◽  
Louis Dale Lowry ◽  
Joseph R. Spiegel
Keyword(s):  
Carotid Artery ◽  
Temporal Bone ◽  
Internal Carotid ◽  
Cranial Nerves ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Bone Resection ◽  
Venous Outflow ◽  
En Bloc ◽  
Temporal Bone Resection

Because of unsatisfactory results in treatment of malignant conditions of the temporal bone, a technique for total en bloc resection of the temporal bone and carotid artery was reported by Graham et al. in 1984. The procedure involves resection of the internal carotid artery, cranial nerves VI through XII, and structures adjacent to the temporal bone. Experience with two additional cases led to numerous modifications in the recommended procedure, as reported by Sataloff and Myers. Additional clinical experience with this technique and its complications has resulted in further modification. Additional pitfalls and specific changes in technique from previous reports are discussed in detail, including a new procedure to assure the adequacy of contralateral venous outflow.

Long-term outcome following radical temporal bone resection for lateral skull base malignancies: a neurosurgical perspective

2008 ◽  
Vol 108 (3) ◽  
pp. 501-510 ◽  
Author(s):  
Nobutaka Kawahara ◽  
Tomio Sasaki ◽  
Takahiro Asakage ◽  
Kazunari Nakao ◽  
Masashi Sugasawa ◽  
...  
Keyword(s):  
Skull Base ◽  
Temporal Bone ◽  
Survival Rates ◽  
Surgical Margin ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Bone Resection ◽  
En Bloc ◽  
Temporal Bone Resection

Object Primary temporal bone malignancy is a rare form of tumor for which the therapeutic strategy remains controversial. In this study, the authors reviewed their experience with radical temporal bone resection (TBR) of such lesions and analyzed the long-term results to provide treatment recommendations. Methods Between 1994 and 2006, 17 patients (10 men and 7 women) underwent total or subtotal TBR for primary temporal bone malignancies. Tumors were graded according to the University of Pittsburgh system. The effects of surgical margins and tumor extensions on patient survival were analyzed using the Kaplan–Meier method. Results All tumors, except 1, were graded T4 (most advanced). Subtotal TBR was performed in 14 patients, and total TBR was performed in 3. The surgical margin was tumor negative in 10 patients and tumor positive in 7. For large tumors extending into the infratemporal fossa or encroaching on the jugular foramen, orbitozygomatic (3 patients) and posterior transjugular (4 patients) approaches were combined with the standard approach, and en bloc resection with a negative margin was achieved in all cases but 1. The follow-up time ranged from 0.3–11.6 years (mean 3.3 years). The 5-year recurrence-free and disease-specific survival rates were 67.5 and 60.1%, respectively. When a negative surgical margin was achieved, the survival rates improved to 100 and 89%, respectively. Conclusions The neurosurgical skull base technique could improve the probability of en bloc resection with a tumor-free margin for extensive temporal bone malignancies, which would cure a subset of patients. The active participation of neurosurgeons would improve patient care in this field.

Clinical Analysis of En Bloc Resection for Advanced Temporal Bone Squamous Cell Carcinoma

2021 ◽  
Author(s):  
Noritaka Komune ◽  
Daisuke Kuga ◽  
Satoshi Matsuo ◽  
Masaru Miyazaki ◽  
Teppei Noda ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Temporal Bone ◽  
Surgical Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Bone Resection ◽  
En Bloc ◽  
Temporal Bone Resection ◽  
Disease Specific

Abstract Objective En bloc and margin-negative surgical resection seems to offer the best prognosis for patients with temporal bone squamous cell carcinoma (TB-SCC). In this study, we summarize the outcomes of surgical cases of advanced TB-SCC (T3–T4) that were managed in two institutions, with an accompanying description of the surgical procedure that was utilized: modified subtotal temporal bone resection (STBR), which involves the en bloc removal of the temporal bone including or transecting the otic capsule. Design This is a case series study with chart review. Setting The study was conducted at two academic tertiary care medical centers. Participants Chart information was collected for all patients who underwent surgical resection of advanced TB-SCC between July 1998 and February 2019. The resulting dataset contained 43 patients with advanced TB-SCC who underwent en bloc resection during the review period. Tumor staging followed the modified Pittsburgh classification. Disease-specific survival (DSS) rates were calculated according to the Kaplan–Meier method. Main Outcome Measure This study shows disease-specific 5-year DSS rate. Results The 5-year DSS rate of the cases who underwent en bloc resection was 79.7%. En bloc lateral temporal bone resection was employed in a total of 25 cases (DSS: 79.0%). En bloc modified STBR was utilized in 18 cases (DSS: 81.7%). Conclusion En bloc margin-negative resection is a reliable treatment strategy for advanced TB-SCC. Modified STBR can be a treatment option for TB-SCC without marked posterior extension.

scholarly journals Variations of en Bloc Resection for Advanced External Auditory Canal Squamous Cell Carcinoma: Detailed Anatomical Considerations

Cancers ◽  
2021 ◽  
Vol 13 (18) ◽  
pp. 4556
Author(s):  
Noritaka Komune ◽  
Daisuke Kuga ◽  
Koichi Miki ◽  
Takashi Nakagawa
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Temporal Bone ◽  
External Auditory Canal ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Surgical Approaches ◽  
Bone Resection ◽  
En Bloc ◽  
Temporal Bone Resection

Currently, only lateral temporal bone resection (LTBR) and subtotal temporal bone resection (STBR) are widely utilized for the surgical treatment of advanced squamous cell carcinoma of the external auditory canal (EAC-SCC). However, there are few descriptions of variations on these surgical approaches. This study aimed to elucidate the variations of en bloc resection for advanced EAC-SCC. We dissected the four sides of cadaveric heads to reveal the anatomical structures related to temporal bone resection. From the viewpoint of surgical anatomy, surgical patterns of temporal bone cutting can be divided into four categories: conventional LTBR, extended LTBR, conventional STBR, and modified STBR. Extended LTBR is divided into four types: superior, inferior, anterior, and posterior extensions. Several extension procedures can be combined based on the extension of the tumor. Furthermore, en bloc resection with the temporomandibular joint or glenoid fossa increases the technical difficulty of a surgical procedure because the exposure and manipulation of the petrous segment of the internal carotid artery are limited from the middle cranial fossa. Surgical approaches for advanced SCC of the temporal bone are diverse. They require accurate preoperative evaluation of the tumor extension and preoperative consideration of the exact line of resection to achieve marginal negative resection.

En bloc temporal bone resection using a diamond threadwire saw for malignant tumors

2011 ◽  
Vol 114 (5) ◽  
pp. 1386-1389 ◽  
Author(s):  
Hiroyuki Jimbo ◽  
Shinetsu Kamata ◽  
Kouki Miura ◽  
Tatsuo Masubuchi ◽  
Megumi Ichikawa ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Temporal Bone ◽  
Internal Carotid ◽  
Malignant Tumors ◽  
Bone Resection ◽  
En Bloc ◽  
Reliable Technique ◽  
Temporal Bone Resection ◽  
A New Technique

The purpose of this study is to describe a new technique for en bloc temporal bone resection using a diamond threadwire saw (T-saw) as an alternative to cutting the temporal bone with an osteotome. This technique has been performed in 10 patients with external auditory canal and middle ear cancers without any injury to the internal carotid artery or jugular vein. The authors conclude that the use of a diamond threadwire saw after transposing the internal carotid artery anteriorly is a safe, simple, and reliable technique for en bloc temporal bone resection.

En bloc subtotal temporal bone resection for cancer of the external ear

1973 ◽  
Vol 39 (3) ◽  
pp. 370-379 ◽  
Author(s):  
Shokei Yamada ◽  
Frederic D. Schuh ◽  
J. Shand Harvin ◽  
Phanor L. Perot
Keyword(s):  
Plastic Surgery ◽  
Temporal Bone ◽  
External Ear ◽  
Bone Resection ◽  
En Bloc ◽  
Large Defect ◽  
Vascular Thrombosis ◽  
Content Type ◽  
Temporal Bone Resection ◽  
Fine Print

✓ The authors report their technical experience with the en bloc subtotal temporal bone resection of cancer of the external ear involving the temporal bone. With the cooperation of an experienced plastic surgery team, coverage of the large defect with a rotation flap makes this procedure successful by wound healing per primam. Complications such as hemorrhage, vascular thrombosis, and brain abscess can be minimized by strict application of neurosurgical and plastic surgery techniques. Two successful cases are described in detail.

En Bloc Subtotal Temporal Bone Resection in a Case of Advanced Ear Cancer: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (4) ◽  
pp. E402-E403
Author(s):  
Hidehito Kimura ◽  
Masaaki Taniguchi ◽  
Hirotaka Shinomiya ◽  
Masanori Teshima ◽  
Yuichi Fujita ◽  
...  
Keyword(s):  
Temporal Bone ◽  
Cancer Control ◽  
Technical Difficulty ◽  
Radical Resection ◽  
Histopathological Diagnosis ◽  
Bone Resection ◽  
En Bloc ◽  
Temporal Bone Resection ◽  
Piecemeal Resection ◽  
Advanced Tumors

Abstract Temporal bone cancer is extremely rare; thus, the optimal surgical strategy for advanced tumors, en bloc vs piecemeal resection, remain controversial. Some authors have favored piecemeal resection and reported comparable outcomes.1 Other authors recommend the use of en bloc subtotal temporal bone resection (STBR) for advanced tumors and reported better outcomes, although long-term cancer control remains uncertain.2 Because of the technical difficulty and the lack of demonstrative surgical videos, STBR has not been sufficiently distributed. This video demonstrates en bloc STBR in a stepwise manner with particular focus on the neurosurgeon's role and aims to improve its safety, feasibility, and distribution. This video conforms to the description of Osawa et al3 in the designations for each segment of the petrous ICA. A 67-yr-old man suffered from consistent otorrhea and underwent tympanoplasty at an outside hospital 1 yr earlier. Following a histopathological diagnosis of squamous cell carcinoma in the specimen, he underwent chemoradiotherapy (cisplatin + 70 Gy). However, a current imaging revealed a recurrent tumor and he was admitted to our hospital for radical resection. Computed tomography revealed a disrupted external auditory canal and magnetic resonance imaging indicated a carcinoma equivalent to Pittsburg stage T3. The patient underwent radical STBR without complications. His postoperative course was uneventful. At 2 yr postoperative, his modified Rankin scale score was 1, no recurrence was noted, and his facial nerve function was restored to House-Brackmann Grade IV. This video was reproduced with informed consent from the patient.

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