Outer Table Graft in Middle Fossa Surgery

1994 ◽  
Vol 111 (1) ◽  
pp. 70-75 ◽  
Author(s):  
Christopher J. Linstrom ◽  
Marek J. Krajewski ◽  
Aaron L. Shapiro ◽  
Salvatore Caruana
Keyword(s):  
Surgical Technique ◽  
Facial Nerve ◽  
Middle Cranial Fossa ◽  
Middle Fossa ◽  
Nerve Decompression ◽  
Cranial Fossa ◽  
Middle Cranial Fossa Surgery ◽  
Facial Nerve Decompression ◽  
Outer Table

We describe a surgical technique in which the middle fossa craniotomy ordinarily used for facial nerve decompression and related surgery is extended superiorly to allow the harvest of a split-thickness calvarial graft. This graft allows the tegmen defect in middle fossa surgery to be repaired without shortening the original craniotomy plate. Avoiding the usual temporoparietal depression after middle cranial fossa surgery is both a structural and cosmetic benefit for the patient.

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.

XXII Middle Fossa Facial Nerve Decompression

1970 ◽  
Vol 79 (2) ◽  
pp. 234-240 ◽  
Author(s):  
Michael E. Glasscock ◽  
William F. House ◽  
Bob R. Alford
Keyword(s):  
Facial Nerve ◽  
Middle Fossa ◽  
Nerve Decompression ◽  
Facial Nerve Decompression

scholarly journals Cerebellopontine angle facial schwannoma relapsing towards middle cranial fossa

2011 ◽  
Vol 1 (2) ◽  
pp. 32 ◽  
Author(s):  
Takafumi Nishizaki ◽  
Norio Ikeda ◽  
Shigeki Nakano ◽  
Takanori Sakakura ◽  
Masaru Abiko ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Cerebellopontine Angle ◽  
Middle Cranial Fossa ◽  
Petrous Bone ◽  
Middle Fossa ◽  
Facial Spasm ◽  
History Of ◽  
Staged Operation ◽  
Cranial Fossa ◽  
Magnetic Resonance Imaging Mri

Facial nerve schwannomas involving posterior and middle fossas are quite rare. Here, we report an unusual case of cerebellopontine angle facial schwannoma that involved the middle cranial fossa, two years after the first operation. A 53-year-old woman presented with a 3-year history of a progressive left side hearing loss and 6-month history of a left facial spasm and palsy. Magnetic resonance imaging (MRI) revealed 4.5 cm diameter of left cerebellopontine angle and small middle fossa tumor. The tumor was subtotally removed via a suboccipital retrosigmoid approach. The tumor relapsed towards middle cranial fossa within a two-year period. By subtemporal approach with zygomatic arch osteotomy, the tumor was subtotally removed except that in the petrous bone involving the facial nerve. In both surgical procedures, intraoperative monitoring identified the facial nerve, resulting in preserved facial function. The tumor in the present case arose from broad segment of facial nerve encompassing cerebellopontine angle, meatus, geniculate/labyrinthine and possibly great petrosal nerve, in view of variable symptoms. Preservation of anatomic continuity of the facial nerve should be attempted, and the staged operation via retrosigmoid and middle fossa approaches using intraoperative facial monitoring, may result in preservation of the facial nerve.

scholarly journals Anatomy of the combined retrolabyrinthine–middle fossa craniotomy

2003 ◽  
Vol 14 (6) ◽  
pp. 1-4 ◽  
Author(s):  
John S. Oghalai ◽  
Robert K. Jackler
Keyword(s):  
Surgical Technique ◽  
Middle Cranial Fossa ◽  
Nerve Function ◽  
Middle Fossa ◽  
Facial Nerve Function ◽  
Petroclival Meningiomas ◽  
Cranial Fossa ◽  
Retrolabyrinthine Approach ◽  
Brain Retraction ◽  
Gain Access

The goal of combined retrolabyrinthine–middle fossa craniotomy is to provide exposure of both the middle and posterior cranial fossae via a partial petrosectomy and division of the tentorium. Its major benefits over others are that hearing and facial nerve function are preserved and only minimal brain retraction is required. The retrolabyrinthine approach involves a presigmoid posterior fossa craniotomy that preserves the structures of the inner ear. Additionally, a middle fossa craniotomy, extending to the zygomatic root, is performed to gain access to the superior aspect of the temporal bone in the middle cranial fossa. This approach works well in cases of lesions involving the petroclival junction, including petroclival meningiomas, trigeminal schwannomas, epidermoids, and large chondrosarcomas or chordomas with intradural components. The authors describe the surgical technique of this approach.

Microsurgical Anatomy of the Perigeniculate Ganglion Area as Seen from a Translabyrinthine Approach

2000 ◽  
Vol 109 (3) ◽  
pp. 255-257 ◽  
Author(s):  
Ho-Ki Lee ◽  
Won-Sang Lee ◽  
Ek-Ho Lee ◽  
Won Sok Kim
Keyword(s):  
Facial Nerve ◽  
Middle Cranial Fossa ◽  
Surgical Anatomy ◽  
Point Of View ◽  
Microsurgical Anatomy ◽  
Translabyrinthine Approach ◽  
Precise Knowledge ◽  
Cranial Fossa ◽  
Temporal Bones ◽  
Facial Nerve Decompression

Detailed anatomic knowledge of the microsurgical anatomy of the perigeniculate ganglion area is essential to probing adjacent to the facial nerve by a translabyrinthine approach. This study was designed to investigate the surgical anatomy of the perigeniculate ganglion area of the facial nerve from a translabyrinthine point of view. We dissected 15 human temporal bones under a microscope, measured the lengths of the tympanic segment and the labyrinthine segment by a middle cranial fossa approach, and measured the angle between the tympanic and labyrinthine segments by a translabyrinthine approach. The distance of the facial nerve from the cochleariform process to the geniculate ganglion was 3.8 ± 0.7 mm. The length of the labyrinthine segment of the facial nerve was 4 ± 0.8 mm. The angle between the tympanic and labyrinthine segments from a translabyrinthine point of view was 26° ± 5°. Precise knowledge about the microsurgical anatomy of the perigeniculate ganglion area of the facial nerve from a translabyrinthine viewpoint is imperative for facial nerve decompression by a translabyrinthine approach.

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