Surgical anatomy training in a dedicated research laboratory and attendance to focused“hands-on”dissection courses are of high educational importance in order to acquire and maintain surgical expertise in skull base...Surgical anatomy training in a dedicated research laboratory and attendance to focused“hands-on”dissection courses are of high educational importance in order to acquire and maintain surgical expertise in skull base surgery,both for young and more experienced surgeons.Nevertheless,transitioning surgical skills and anatomic knowledge from the laboratory to the operative room it is not free of challenges,especially during skull base approaches where the three-dimensional surgical orientation can be quite complex.We present a“step-by-step”and“side-by-side”surgical anatomy report on a translabyrinthine approach that was practiced in the laboratory then performed in the operative room by the surgical team,and we compare surgical anatomy exposures while discussing intraoperative techniques,nuances and challenges,both in the laboratory and the operative room.展开更多
Objective:To describe the procedure and results of an adapted closure and recon struction technique for translabyrinthine surgery that focuses on identifying and managing potential pathways for CSF egress to the middl...Objective:To describe the procedure and results of an adapted closure and recon struction technique for translabyrinthine surgery that focuses on identifying and managing potential pathways for CSF egress to the middle ear and Eustachian tube.Methods:Retrospective review of a cohort of translabyrinthine acoustic neuroma cases that were reconstructed using this technique.Results:In addition to meticulous packing of potential conduits using soft tissue,hydroxyapatite cement is used to seal opened air cell tracts prior to obliteration of the mastoid defect using adipose tissue.Early results of a small patient cohort using this technique are encouraging and there were no wound infections.There was a single case of CSF rhinorrhea associated with incomplete sealing of opened petrous apex cells,with no recurrence after appropriate implementation of the described protocol during revision surgery.Conclusion:Proactive management of potential conduits of CSF egress including opened air cell tracts has a high likelihood of reducing rates of rhinorrhea and need for revision surgery after the translabyrinthine approach to the posterior fossa.展开更多
Cholesteatoma is a fairly otologic common problem. However, cholesteatoma invading the internal auditory canal (IAC) is rare and typically results in profound hearing loss and facial paralysis. This is a case of a 46-...Cholesteatoma is a fairly otologic common problem. However, cholesteatoma invading the internal auditory canal (IAC) is rare and typically results in profound hearing loss and facial paralysis. This is a case of a 46-year-old female with a history of prior right complex cholesteatoma that had undergone multiple procedures. She had multiple complications including right cerebral spinal fluid (CSF) leak, meningitis, recurrent mastoid bowl infections and right facial paralysis which resulted in multiple facial plastics procedures and overclosure of the right ear. Over the last three years, she has noticed an increase in right sided otalgia, facial pressure, facial numbness and headaches. An MRI temporal bone with diffusion weighted imaging (DWI) showed a DW positive soft tissue mass filling the mastoid bowl as well as extending into the IAC and cerebellar pontine angle (CPA) cistern with contact of the middle cerebellar peduncle and trigeminal nerve. A translabyrinthine approach to the IAC found the mastoid bowl to be filled with cholesteatoma and an osseous defect from the mastoid bowl along the labyrinthine facial nerve tracking cholesteatoma into the IAC/CPA. This case highlights the complex and aggressive nature a cholesteatoma can take and the need for diligent surveillance in any ear that had prior cholesteatoma. The utilizations of MRI temporal bone with diffusion weighted imaging allow for surveillance in an over closed ear canal that is vital to the care of cholesteatoma patients who have a similar history.展开更多
Intratemporal facial nerve schwannoma(FNS) are rare benign tumors of the skull base. Many of these tumors will be detected during evaluation for symptoms suggestive of vestibular schwannoma. However, there are several...Intratemporal facial nerve schwannoma(FNS) are rare benign tumors of the skull base. Many of these tumors will be detected during evaluation for symptoms suggestive of vestibular schwannoma. However, there are several signs and symptoms which can suggest the facial nerve as the origin of the tumor. Intratemporal FNS can be multiple, like "beads on a string", or solitary lesions of the internal auditory canal. This variable tumormorphology necessitates multiple treatment options to allow patients the best chance of preservation of facial nerve function. Historically FNS were managed with resection of the nerve with cable grafting. However this leaves the patient with permanent facial weakness and asymmetry. Currently most patients find this outcome unacceptable, especially when they present with good to normal facial nerve function. Facial paralysis has a significantly negative impact on quality life, so treatment regimens that spare facial nerve function have been used in patients who present with moderate to good facial nerve function. Nerve sparing options include tumor debulking, decompression of the bony facial canal, radiosurgery, and observation. The choice of management depends on the degree of facial nerve dysfunction at presentation, hearing status in the affected ear, medical comorbidities and patient preference. Each treatment option will be discussed in detail and suggestions for patient management will be presented.展开更多
Background: Intracranial schwannomas of the accessory nerve are very rare lesions. They are categorised according to their locations into either intrajugular or intracistemal schwannomas although most of them are intr...Background: Intracranial schwannomas of the accessory nerve are very rare lesions. They are categorised according to their locations into either intrajugular or intracistemal schwannomas although most of them are intrajugular. The intrajugular type constitutes about 2% to 4% of all intracranial schwannomas described in literature. Aim: It’s very unusual for an accessory nerve to mimic glossopharyngeal nerve looking at the anatomical location of the accessory nerve. Although many authors have written on accessory nerve, none have described this unusual presentation. We present a case, management as well as review on the classification and appropriate surgical techniques we could have use to access the tumor in our patient since the choice of a particular surgical approach is based on the nature of tumor, location as well as it extension into other adjacent structures. Case Presentation: We present a case of 52-year-old woman with very unusual accessory nerve schwannoma which mimics the clinical presentation of glossopharyngeal nerve tumor. The main symptom in our case is six (6) months history of deviation of the tongue to right side with dizziness and change of voice. Conclusion: The unusual presentation in our case could be due to massive compression of glossopharyngeal nerve by the growing accessory nerve schwannoma since most lower cranial nerve schwannomas at this location will almost always course compressive symptoms.展开更多
文摘Surgical anatomy training in a dedicated research laboratory and attendance to focused“hands-on”dissection courses are of high educational importance in order to acquire and maintain surgical expertise in skull base surgery,both for young and more experienced surgeons.Nevertheless,transitioning surgical skills and anatomic knowledge from the laboratory to the operative room it is not free of challenges,especially during skull base approaches where the three-dimensional surgical orientation can be quite complex.We present a“step-by-step”and“side-by-side”surgical anatomy report on a translabyrinthine approach that was practiced in the laboratory then performed in the operative room by the surgical team,and we compare surgical anatomy exposures while discussing intraoperative techniques,nuances and challenges,both in the laboratory and the operative room.
文摘Objective:To describe the procedure and results of an adapted closure and recon struction technique for translabyrinthine surgery that focuses on identifying and managing potential pathways for CSF egress to the middle ear and Eustachian tube.Methods:Retrospective review of a cohort of translabyrinthine acoustic neuroma cases that were reconstructed using this technique.Results:In addition to meticulous packing of potential conduits using soft tissue,hydroxyapatite cement is used to seal opened air cell tracts prior to obliteration of the mastoid defect using adipose tissue.Early results of a small patient cohort using this technique are encouraging and there were no wound infections.There was a single case of CSF rhinorrhea associated with incomplete sealing of opened petrous apex cells,with no recurrence after appropriate implementation of the described protocol during revision surgery.Conclusion:Proactive management of potential conduits of CSF egress including opened air cell tracts has a high likelihood of reducing rates of rhinorrhea and need for revision surgery after the translabyrinthine approach to the posterior fossa.
文摘Cholesteatoma is a fairly otologic common problem. However, cholesteatoma invading the internal auditory canal (IAC) is rare and typically results in profound hearing loss and facial paralysis. This is a case of a 46-year-old female with a history of prior right complex cholesteatoma that had undergone multiple procedures. She had multiple complications including right cerebral spinal fluid (CSF) leak, meningitis, recurrent mastoid bowl infections and right facial paralysis which resulted in multiple facial plastics procedures and overclosure of the right ear. Over the last three years, she has noticed an increase in right sided otalgia, facial pressure, facial numbness and headaches. An MRI temporal bone with diffusion weighted imaging (DWI) showed a DW positive soft tissue mass filling the mastoid bowl as well as extending into the IAC and cerebellar pontine angle (CPA) cistern with contact of the middle cerebellar peduncle and trigeminal nerve. A translabyrinthine approach to the IAC found the mastoid bowl to be filled with cholesteatoma and an osseous defect from the mastoid bowl along the labyrinthine facial nerve tracking cholesteatoma into the IAC/CPA. This case highlights the complex and aggressive nature a cholesteatoma can take and the need for diligent surveillance in any ear that had prior cholesteatoma. The utilizations of MRI temporal bone with diffusion weighted imaging allow for surveillance in an over closed ear canal that is vital to the care of cholesteatoma patients who have a similar history.
文摘Intratemporal facial nerve schwannoma(FNS) are rare benign tumors of the skull base. Many of these tumors will be detected during evaluation for symptoms suggestive of vestibular schwannoma. However, there are several signs and symptoms which can suggest the facial nerve as the origin of the tumor. Intratemporal FNS can be multiple, like "beads on a string", or solitary lesions of the internal auditory canal. This variable tumormorphology necessitates multiple treatment options to allow patients the best chance of preservation of facial nerve function. Historically FNS were managed with resection of the nerve with cable grafting. However this leaves the patient with permanent facial weakness and asymmetry. Currently most patients find this outcome unacceptable, especially when they present with good to normal facial nerve function. Facial paralysis has a significantly negative impact on quality life, so treatment regimens that spare facial nerve function have been used in patients who present with moderate to good facial nerve function. Nerve sparing options include tumor debulking, decompression of the bony facial canal, radiosurgery, and observation. The choice of management depends on the degree of facial nerve dysfunction at presentation, hearing status in the affected ear, medical comorbidities and patient preference. Each treatment option will be discussed in detail and suggestions for patient management will be presented.
文摘Background: Intracranial schwannomas of the accessory nerve are very rare lesions. They are categorised according to their locations into either intrajugular or intracistemal schwannomas although most of them are intrajugular. The intrajugular type constitutes about 2% to 4% of all intracranial schwannomas described in literature. Aim: It’s very unusual for an accessory nerve to mimic glossopharyngeal nerve looking at the anatomical location of the accessory nerve. Although many authors have written on accessory nerve, none have described this unusual presentation. We present a case, management as well as review on the classification and appropriate surgical techniques we could have use to access the tumor in our patient since the choice of a particular surgical approach is based on the nature of tumor, location as well as it extension into other adjacent structures. Case Presentation: We present a case of 52-year-old woman with very unusual accessory nerve schwannoma which mimics the clinical presentation of glossopharyngeal nerve tumor. The main symptom in our case is six (6) months history of deviation of the tongue to right side with dizziness and change of voice. Conclusion: The unusual presentation in our case could be due to massive compression of glossopharyngeal nerve by the growing accessory nerve schwannoma since most lower cranial nerve schwannomas at this location will almost always course compressive symptoms.
