Endoscopic balloon dilation as an adjunct to extended endoscopic approaches to the skull base

2012 ◽  
Vol 116 (6) ◽  
pp. 1215-1218 ◽  
Author(s):  
Jeffrey C. Bedrosian ◽  
Victor Garcia-Navarro ◽  
Edward D. McCoul ◽  
Vijay K. Anand ◽  
Theodore H. Schwartz
Keyword(s):  
Balloon Dilation ◽  
Middle Cranial Fossa ◽  
Petrous Apex ◽  
Invasive Technique ◽  
Surgical Removal ◽  
Endoscopic Drainage ◽  
Endoscopic Endonasal ◽  
Access Method ◽  
Cranial Fossa

Cholesterol granulomas (CGs) are benign, expanding cystic lesions surrounded by a thick fibrous capsule and filled with fluid, formed by the degradation of blood elements. The goal of surgery is to open the granuloma widely, creating a well-drained cavity. The endonasal endoscopic approach for this extradural lesion is a minimal access method for surgical removal or fenestration. The role of balloon dilation in creating a wide fenestration has not been previously described. The authors describe a patient with a recurrent petrous apex CG who underwent an endoscopic, endonasal, transmaxillary transpterygoid approach to the petrous apex. A balloon sinuplasty catheter was used to dilate the surgical fenestration to maintain continued patency. The authors report on their first experience using balloon dilation combined with endoscopic drainage of the petrous apex. The excellent surgical outcome of this minimally invasive technique holds promise for future endonasal approaches to the middle cranial fossa.

Endoscopic Endonasal Versus Transorbital Surgery for Middle Cranial Fossa Tumors: Comparison of Clinical Outcomes Based on Surgical Corridors

2019 ◽  
Vol 122 ◽  
pp. e1491-e1504 ◽  
Author(s):  
Min Ho Lee ◽  
Sang Duk Hong ◽  
Kyung In Woo ◽  
Yoon-Duck Kim ◽  
Jung Won Choi ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Middle Cranial Fossa ◽  
Endoscopic Endonasal ◽  
Cranial Fossa

Facial Nerve Neuroma

1994 ◽  
Vol 73 (10) ◽  
pp. 721-752 ◽  
Author(s):  
Jack L. Pulec
Keyword(s):  
Facial Nerve ◽  
Signs And Symptoms ◽  
Middle Cranial Fossa ◽  
Nerve Graft ◽  
Surgical Removal ◽  
Optimal Conditions ◽  
Anatomic Site ◽  
Cranial Fossa ◽  
Slow Growing ◽  
Facial Function

Facial nerve neuromas are uncommon, slow-growing neoplasms that may occur anywhere along the course of the facial nerve from the brainstem to the facial muscles. The signs and symptoms are characteristic and vary with the anatomic site of origin. Surgery should not be attempted until a complete and thorough diagnostic examination has been completed. The surgeon should be prepared to perform a middle-cranial fossa or translabyrinthine approach in all cases, and must expect to do a nerve graft. The results of 37 patients treated by the author reveal that, under optimal conditions, patients who have had a facial nerve graft, can be expected to regain an average of 80 % facial nerve strength in almost every case. All patients who have had a facial nerve graft will have some degree of synkinesis. No graft was required in 3 patients, and a hypoglossal facial anastomosis was used for one. Facial function was completely normal in 2 patients, 16 had 80 – 90 % return, 5 patients had 50 – 80 % return, 4 had 20 – 50% return, one had no recovery at all and 9 recent patients have not reached the time for their expected recovery. Early diagnosis, prompt surgical removal and VII - VII Nerve graft for facial paralysis of ten or fewer years duration offers patients the best opportunity to avoid a permanent facial palsy.

Endoscopic treatment of middle cranial fossa arachnoid cysts in children

2012 ◽  
Vol 9 (3) ◽  
pp. 231-238 ◽  
Author(s):  
Nasser M. F. El-Ghandour
Keyword(s):  
Middle Cranial Fossa ◽  
Arachnoid Cysts ◽  
Cyst Size ◽  
Intraoperative Bleeding ◽  
Initial Surgery ◽  
Significant Clinical Improvement ◽  
Recovery Times ◽  
Cranial Fossa

Object Arachnoid cysts located in the middle cranial fossa are common, comprising about half of all intracranial arachnoid cysts. The management of these cysts is challenging, and the optimal surgical treatment is controversial. This study evaluates the role of endoscopy in the treatment of middle cranial fossa arachnoid cysts (MCFACs) in children, focusing on some factors or technical aspects that might influence the outcome. Methods Thirty-two children with symptomatic MCFACs were the subject of this study. The group included 23 boys and 9 girls, with a mean age of 3.6 years. All patients underwent operations using a purely endoscopic cystocisternostomy procedure through a transtemporal approach. Results Significant clinical improvement occurred in 28 cases (87.5%). Postoperative MR imaging showed a reduction in cyst size in 23 cases (71.9%), whereas in the remaining 9 cases (28.1%), the cyst size was unchanged. Minor intraoperative bleeding occurred in 3 cases (9.4%), which stopped spontaneously without any postoperative sequelae. Ipsilateral subdural hygroma occurred in 2 cases (6.3%) and resolved within a few weeks without surgery; transient oculomotor palsy occurred in 1 case (3.1%). During follow-up (mean 4.6 years), 3 patients (9.4%) experienced recurrence of symptoms and an increase in cyst size. Interestingly, all 3 patients who had recurrence had also experienced intraoperative bleeding at initial surgery. At a second endoscopic procedure, the fenestration was found to be closed in all 3 patients. Conclusions Endoscopic cystocisternostomy is recommended in the treatment of MCFACs in children because it is simple, minimally invasive, and effective. It maintains the basic strategy of cyst fenestration into the basal cisterns without the invasiveness of open craniotomy. This procedure reduces operative and recovery times and is associated with low morbidity and mortality rates.

Anterior inferior petrosectomy: defining the role of endonasal endoscopic techniques for petrous apex approaches

2014 ◽  
Vol 120 (6) ◽  
pp. 1321-1325 ◽  
Author(s):  
Jamie J. Van Gompel ◽  
Puya Alikhani ◽  
Mark H. Tabor ◽  
Harry R. van Loveren ◽  
Sivero Agazzi ◽  
...  
Keyword(s):  
3D Modeling ◽  
Jugular Foramen ◽  
Contralateral Side ◽  
Petrous Apex ◽  
Endoscopic Endonasal ◽  
Endoscopic Techniques ◽  
Inferior Portion ◽  
Anterior Petrosectomy ◽  
Superior Portion

Object Historically, surgery to the petrous apex has been addressed via craniotomy and open microscopic anterior petrosectomy (OAP). However, with the popularization of endoscopic approaches, the petrous apex can further be approached endonasally by way of an endoscopic endonasal anterior petrosectomy (EAP). Endonasal anterior petrosectomy is a relatively new procedure and has not been compared anatomically with OAP. The authors hypothesized that the EAP and OAP techniques approach different portions of the petrous apex and therefore may have different applications. Methods Four cadaveric heads were used. An OAP was performed on one side and an EAP was performed on the contralateral side; the limits of bony resection were defined. The extent of bony resection was then evaluated using predissection and postdissection thin-slice CT scans. The comparative resection was then reconstructed using 3D modeling on Brainlab workstations. Results The average resection volumes for EAP and OAP were 0.297 cm3 and 0.649 cm3, respectively, representing a comparative percentage of 46% (EAP/OAP). An EAP and OAP achieved resection of 29% and 64% of the total petrous apex volume, respectively. Indeed, EAP addressed the inferior portion of the petrous apex located adjacent to the petroclival suture more completely than OAP, where 45% of the bone overlying the petroclival suture (petroclival angle to the jugular foramen) was resected with the EAP, while 0% was resected with the OAP. Conclusions In anatomically normal cadavers, OAP achieved nearly a 50% larger volumetric resection than EAP. Furthermore, while OAP appears to completely address the superior portion of the petrous apex, EAP appears to have a niche in approaches to lesions in the inferior petrous apex. Given these results, the authors propose that OAP be redefined as the “superior anterior petrosectomy,” while EAP be referred to as the “inferior anterior petrosectomy,” which more clearly defines the role of each approach in anterior petrosectomy.

scholarly journals Endoscopic Endonasal Approach to the Middle Cranial Fossa through the Cavernous Sinus Triangles: Anatomical Considerations

2014 ◽  
Vol 54 (12) ◽  
pp. 1004-1008 ◽  
Author(s):  
Fuminari KOMATSU ◽  
Shinri ODA ◽  
Masami SHIMODA ◽  
Masaaki IMAI ◽  
Hideaki SHIGEMATSU ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Middle Cranial Fossa ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Cranial Fossa

scholarly journals THE MIDDLE CRANIAL FOSSA APPROACH TO THE PETROUS APEX

1976 ◽  
Vol 86 (5) ◽  
pp. 658-663 ◽  
Author(s):  
E L Hendershot ◽  
J W Wood ◽  
D Bennhoff
Keyword(s):  
Middle Cranial Fossa ◽  
Petrous Apex ◽  
Middle Cranial Fossa Approach ◽  
Cranial Fossa

scholarly journals Histological Characteristics of Ligaments between Middle Ear and Temporomandibular Joint

2009 ◽  
Vol 03 (04) ◽  
pp. 280-284 ◽  
Author(s):  
Metin Sencimen ◽  
Altan Varol ◽  
Baris Baykal ◽  
Hasan Ayberk Altug ◽  
Necdet Dogan ◽  
...  
Keyword(s):  
Temporomandibular Joint ◽  
Middle Ear ◽  
Structural Characteristics ◽  
Middle Cranial Fossa ◽  
Elastic Fibers ◽  
Compensatory Mechanism ◽  
Functional Tests ◽  
Histological Characteristics ◽  
Cranial Fossa

ABSTRACTObjectives: To examine histological aspects of the ligaments between the middle ear and temporomandibular joint and suppose a theoretical role of their structural characteristics on mobility of mallear ossicle.Methods: The ligaments were obtained by microdissection of middle cranial fossa on both sites of 15 cadavers fixed in formalin solution and were sectioned longitudinally (7-10 µm thickness). The sections were stained with Verhoff’s Van Gieson’s stain (VVG) for demonstration of elastic fibers and visualized at X2.5 and X10 magnifications under light microscopy.Results: Anterior mallear ligament (AML) and sphenomandibular ligaments (SML) were consisted of collagen fibres in analyzed specimens. The discomallear ligament (DML) was constituted of rich collagenous fibres. One specimen of DML harvested between petrotympanic fissure and retrodiscal-capsular intersection site contained elastic fibers dispersed in cotton-bowl appearance between collagen fibers. In the light of functional tests performed in previous studies, it could be extrapolated that presence of elastic fibers in the DML may prevent excessive forces conducted to mallear head by elongation of elastic fibers.Conclusions: Collagenous fibres have no ability to stretch along their axis which may lack compensatory mechanism to prevent mallear head mobility. (Eur J Dent 2009;3:280-284)

scholarly journals Large Cholesterol Granuloma of the Middle Ear Eroding into the Middle Cranial Fossa

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Tessei Kuruma ◽  
Tohru Tanigawa ◽  
Yasue Uchida ◽  
Ogawa Tetsuya ◽  
Hiromi Ueda
Keyword(s):  
Middle Ear ◽  
Middle Cranial Fossa ◽  
Uneventful Recovery ◽  
Petrous Apex ◽  
Cholesterol Granuloma ◽  
Canal Wall ◽  
Cortical Mastoidectomy ◽  
Cranial Fossa ◽  
Canal Wall Down

Background. Cholesterol granuloma of the middle ear is extremely rare in comparison to cholesterol granuloma of the petrous apex but sometimes shows an aggressive course.Case Report. We report herein a case involving a large, aggressive cholesterol granuloma of the middle ear that eroded the middle cranial fossa. A 64-year-old woman presented with pain in the left ear and hearing loss. Cholesterol granuloma was finally diagnosed from diffusion-weighted imaging, and cortical mastoidectomy was performed with canal wall down tympanoplasty type III. Recovery was uneventful recovery and the patient well at the 3-year follow-up.Conclusion. This case demonstrates the rare but clinically important pathology of aggressive cholesterol granuloma of the middle ear.

Giant-cell tumor of the middle cranial fossa

1987 ◽  
Vol 66 (6) ◽  
pp. 924-928 ◽  
Author(s):  
J. Max Findlay ◽  
David Chiasson ◽  
Alan R. Hudson ◽  
Mario Chui
Keyword(s):  
Giant Cell Tumor ◽  
Giant Cell ◽  
Adjuvant Radiotherapy ◽  
Middle Cranial Fossa ◽  
Cell Tumor ◽  
Content Type ◽  
Cranial Fossa ◽  
The Right ◽  
Fine Print

✓ The authors report the case of a 23-year-old man with a giant-cell tumor of the right middle cranial fossa floor. His presentation and management are described, and some aspects of this rare neoplasm of the skull base are reviewed. The role of adjuvant radiotherapy is discussed.

Surgical Anatomy of the Petrous Apex as it Relates to the Enlarged Middle Cranial Fossa Approaches

1994 ◽  
Vol 111 (4) ◽  
pp. 488-493 ◽  
Author(s):  
Maged B. Naguib ◽  
Miguel Aristegui ◽  
Essam Saleh ◽  
Yasar Cokkeser ◽  
Mauro Landolfi ◽  
...  
Keyword(s):  
Middle Cranial Fossa ◽  
Surgical Anatomy ◽  
Petrous Apex ◽  
Gasserian Ganglion ◽  
Posterior Border ◽  
Cranial Fossa ◽  
Temporal Bones

This work was designed to study the surgical anatomy of the petrous apex as it relates to the enlarged middle cranial fossa approaches, on 25 temporal bones. In this study we suggest dividing the petrous apex into two topographic areas: an anterior triangular and a posterior quadrangular area with respect to the posterior border of the Gasserian ganglion. Anatomic descriptions endorsed by relevant measurements of these areas are provided in this study.

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