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
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
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
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.
