scholarly journals Middle cranial fossa approach for acoustic neuroma

2021 ◽  
Vol 5 (2) ◽  
pp. V12
Author(s):  
Paul W. Gidley ◽  
Joel Z. Passer ◽  
Joshua C. Page ◽  
Franco DeMonte
Keyword(s):  
Acoustic Neuroma ◽  
Hearing Preservation ◽  
Middle Cranial Fossa ◽  
Middle Fossa ◽  
Surgical Indications ◽  
Total Resection ◽  
Technical Aspects ◽  
Middle Fossa Approach ◽  
Acoustic Neuromas ◽  
Cranial Fossa

The middle fossa approach for the resection of small acoustic neuromas is a viable, but underutilized treatment modality with the goal of hearing preservation. The authors aim to demonstrate this approach and its nuances through this video presentation. A 38-year-old man presented with an incidentally discovered small, intracanalicular acoustic neuroma that was initially observed, but growth was noted. The patient had good hearing, and therefore a hearing preservation approach was offered. A gross-total resection was achieved, and the patient maintained good hearing postoperatively. This video demonstrates relevant anatomy, surgical indications, technical aspects of resection, including reconstruction, and postoperative outcomes. The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID21124

Hearing preservation in acoustic neuroma surgery: importance of adhesion between the cochlear nerve and the tumor

2002 ◽  
Vol 97 (2) ◽  
pp. 337-340 ◽  
Author(s):  
Takuzou Moriyama ◽  
Takanori Fukushima ◽  
Katsuyuki Asaoka ◽  
Pierre-Hugues Roche ◽  
David M. Barrs ◽  
...  
Keyword(s):  
Acoustic Neuroma ◽  
Hearing Preservation ◽  
Cochlear Nerve ◽  
Significant Prognostic Factor ◽  
Speech Discrimination ◽  
Middle Fossa ◽  
Content Type ◽  
Middle Fossa Approach ◽  
Acoustic Neuromas ◽  
Fine Print

Object. To evaluate the possible prognostic factors for hearing preservation, the authors retrospectively reviewed the results of 30 consecutive acoustic neuroma operations in which hearing preservation was attempted, in a total series of 63 acoustic neuromas. Methods. Intracanalicular tumors or those that extended less than 3 mm outside the porus acusticus (10 cases) were resected via the middle fossa approach. The retrosigmoid approach was used for tumors exceeding the limits for the middle fossa approach (20 cases). Overall, hearing was preserved (pure tone average ≤ 50 dB and speech discrimination score ≥ 50%) in 21 patients (70%). There were 11 patients with severe adhesion between the cochlear nerve and tumor capsule, and 19 without. Hearing was preserved postoperatively in only two (18.2%) of 11 patients with severe adhesion, whereas all 19 without severe adhesion had hearing preservation. Conclusions. The presence or absence of severe adhesion in the interface between the cochlear nerve and the tumor might be the most significant prognostic factor for hearing preservation postsurgery.

Hearing preservation despite labyrinthectomy for resection of giant cholesteatoma with middle fossa extension

1998 ◽  
Vol 112 (5) ◽  
pp. 472-475 ◽  
Author(s):  
F. Rapado ◽  
N. Fergie ◽  
R. T. Ramsden
Keyword(s):  
Middle Ear ◽  
Bone Conduction ◽  
Mass Effect ◽  
Hearing Preservation ◽  
Middle Cranial Fossa ◽  
Middle Fossa ◽  
Bone Conduction Threshold ◽  
Acquired Cholesteatoma ◽  
Cranial Fossa ◽  
Middle Ear Cleft

AbstractA case is described of an extensive acquired cholesteatoma of the middle ear cleft which had invaded the middle cranial fossa and produced a mass effect on the temporal lobe. It had also extended into the labyrinth without causing elevation in the bone conduction threshold. Furthermore, even after total bony labyrinthectomy, there was very little elevation in these thresholds. The literature relating to hearing preservation after labyrinthectomy is reviewed.

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.

Acquired Middle Cranial Fossa Fistulas

Neurosurgery ◽  
1979 ◽  
Vol 5 (4) ◽  
pp. 466-472 ◽  
Author(s):  
Benjamin Kaufman ◽  
Howard Yonas ◽  
Robert J. White ◽  
Clinton F. Miller
Keyword(s):  
Cerebrospinal Fluid ◽  
Normal Population ◽  
Normal Pressure ◽  
Middle Cranial Fossa ◽  
Csf Leak ◽  
Middle Fossa ◽  
Middle Fossa Approach ◽  
Cranial Fossa ◽  
Definition Of ◽  
Base Of The Skull

Abstract To the accepted classification of three types of normal pressure, nontraumatic cerebrospinal fluid (CSF) fistulas, we would add “acquired.” This type of CSF fistula tends to occur from the middle cranial fossa because of the enlargement of “pitholes” that are normally present in its anterior medial aspect. The enlargement of these bony defects is due to normal intracranial pressure variations that, not uncommonly, create meningoceles and meningoencephaloceles. A portion of the floor of this area is aerated in up to 10% of the normal population by the lateral recess of the sphenoid sinus, the pterygoid recess. Thus, this area has the potential to act as a pathway between the middle fossa and the paranasal sinuses, allowing cerebrospinal fluid to pass into the sinuses. Isotope and computerized tomographic studies are helpful in the localization of such a CSF leak. Tomography of the base of the skull, however, is essential for the ideal definition of possible routes of fistulization. If there is any question of the presence of a middle fossa fistula, these studies can show whether the floor of this area is pneumatized and whether there are any defects in the floor. The treatment of such a fistula should include generalized reinforcement of the floor of the anterior middle fossa by a middle fossa approach. If any doubt exists as to the site of leakage (anterior or middle fossa), the minimal surgical procedure should include exploration of both areas via a frontotemporal craniotomy.

Preservation of hearing in surgery for acoustic neuromas

1993 ◽  
Vol 78 (6) ◽  
pp. 864-870 ◽  
Author(s):  
Michael E. Glasscock ◽  
James W. Hays ◽  
Lloyd B. Minor ◽  
David S. Haynes ◽  
Vincent N. Carrasco
Keyword(s):  
Hearing Preservation ◽  
Middle Cranial Fossa ◽  
Senior Author ◽  
Speech Discrimination ◽  
Content Type ◽  
Auditory Evoked Response ◽  
Surgical Access ◽  
Acoustic Neuromas ◽  
Cranial Fossa ◽  
Fine Print

✓Preservation of hearing was attempted in 161 cases of histologically confirmed acoustic neuroma removed by the senior author between January 1, 1970, and September 30, 1991. There were 136 patients with unilateral tumors: 22 patients had bilateral tumors (neurofibromatosis 2) and underwent a total of 25 procedures. Hearing was initially preserved in 35% of patients with unilateral tumors and in 44% of those with bilateral tumors. Results are reported in terms of pre- and postoperative pure tone average and speech discrimination scores. Surgical access to the tumor was obtained via middle cranial fossa and suboccipital approaches. The latter has been used more often over the past 5 years because of a lower associated incidence of transient facial paresis. Persistent postoperative headaches have been the most common complication following the suboccipital approach. The results of preoperative brain-stem auditory evoked response (BAER) studies were useful in predicting the outcome of hearing preservation attempts. Patients with intact BAER waveform morphology and normal or delayed latencies had a higher probability of hearing preservation in comparison to those with abnormal preoperative BAER morphology.

Hearing Preservation in Acoustic Neuroma Surgery by the Extended Middle Cranial Fossa Method

1991 ◽  
Vol 111 (sup487) ◽  
pp. 22-29 ◽  
Author(s):  
Jin Kanzaki ◽  
Kaoru Ogawa ◽  
Toshiaki O-uchi ◽  
Ryuzo Shiobara ◽  
Shigeo Toya
Keyword(s):  
Acoustic Neuroma ◽  
Hearing Preservation ◽  
Middle Cranial Fossa ◽  
Acoustic Neuroma Surgery ◽  
Cranial Fossa

Lateral Orbitotomy Approach for Lesions Involving the Middle Fossa: A Retrospective Review of Thirteen Patients

Neurosurgery ◽  
2017 ◽  
Vol 80 (2) ◽  
pp. 309-322 ◽  
Author(s):  
Joseph D. Chabot ◽  
Paul A. Gardner ◽  
S. Tonya Stefko ◽  
Nathan T. Zwagerman ◽  
Juan Carlos Fernandez- Miranda
Keyword(s):  
Visual Acuity ◽  
Cavernous Sinus ◽  
Middle Cranial Fossa ◽  
Symptomatic Improvement ◽  
Middle Fossa ◽  
Total Resection ◽  
Patients Âgés ◽  
Lateral Orbitotomy ◽  
Patient Reported ◽  
Cranial Fossa

Abstract BACKGROUND: Classically used for treatment of orbital lesions, the lateral orbitotomy with cantholysis can be combined with a temporal craniectomy for lesions involving the middle cranial fossa. OBJECTIVE: To present a single-center experience with the lateral orbitotomy approach for lesions involving the middle fossa. METHODS: Twenty-five patients underwent lateral orbitotomies from April 2012 to July 2015. Excluding patients with solely intraorbital pathologies, 13 patients’ clinical and radiographic records were retrospectively reviewed. RESULTS: Signs/symptoms in the 13 patients (ages 28-81) included proptosis (69%), decreased visual acuity (31%), diplopia (54%), and afferent pupillary defect (69%). Pathologies were meningioma (8), esthesioneuroblastoma, lymphoma, chordoma, Ewing's sarcoma, and squamous cell carcinoma. Surgical goals were maximal safe resection in 8 patients, palliative debulking in 3 patients, and cavernous sinus biopsy in 2 patients. In 8 patients for whom maximal resection was the goal, 2 had gross total resection, while 6 had near-total resection. All patients (3) for whom palliation was the goal had symptomatic improvement. Both cavernous sinus biopsies obtained diagnostic tissue without complications. All patients with proptosis (n = 9) and diplopia (n = 7), and 2 of 4 patients with decreased visual acuity had improvement in their symptoms. No patient reported worsening of their symptoms. Mean follow-up was 12 mo (2-30 mo). Complications included oculorrhea (1), pseudomeningocele (2), transient ptosis (2), and forehead numbness (1). CONCLUSION: The lateral orbitotomy is a promising approach for carefully selected lesions with involvement of both the lateral orbit and middle cranial fossa. It provides minimally invasive access for biopsy, decompression, or resection.

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