A Logical Surgical Approach to the Tip Cells of the Petrous Pyramid

Dearmin, Robert M.

doi:10.1001/archotol.1937.00650020342008

Cited by 16 publications

(7 citation statements)

References 3 publications

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“…The transmastoid infralabyrinthine approach was described by Dearmin in 1937 13 and has advantages of hearing preservation, preservation of facial nerve function, and maintenance of the posterior wall of the external auditory canal. Wider access at the mastoid becomes severely restricted more deeply, however, by the jugular bulb that may severely limit or prevent access to the petrous apex in as many as 50% of cases based on cadaveric temporal bone dissection 14,15 or in 74% of cases based on computed tomography (CT) imaging.…”

Section: Introductionmentioning

confidence: 99%

Decompression of the Jugular Bulb for Enhanced Infralabyrinthine Access to the Petroclival Region: A Quantitative Analysis

et al. 2015

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Objectives To describe an enhanced infralabyrinthine approach to petroclival lesions with jugular bulb decompression, and to quantify surgical access using a flat-panel computed tomography image protocol. Design Retrospective case series and paired comparison of pre- versus post-dissection anatomy. Setting Tertiary academic medical center. Participants Four patients presenting with petroclival lesions. Six fresh cadaveric specimens were used for temporal bone dissection. Main Outcome Measures Axial and coronal dimensions, and access angles of the infralabyrinthine surgical corridor. Results Decompression of the jugular bulb increased the craniocaudal width of the infralabyrinthine corridor from 0.9 to 7.9 mm to 6.5 to 11.6 mm. The mean increase of 4 mm was statistically significant (t = 3.7; p < .05). There was also a significant widening of the infralabyrinthine window along the axial dimension by 0.9 to 4.5 mm or a mean of 2 mm (t = 3.7; p < .05). Angles of access to the petroclival region were wider following jugular bulb decompression, particularly in the coronal plane (mean difference 7.9 degrees; t = 5.0; p < .005) but less so in the axial plane (mean difference 4.7 degrees; t = 2.5; p = .05). Conclusions Jugular bulb decompression enhances infralabyrinthine access to petroclival lesions, permitting the removal of tissue for diagnoses or partial resection, without significant additional morbidity.

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Section: Introductionmentioning

confidence: 99%

Decompression of the Jugular Bulb for Enhanced Infralabyrinthine Access to the Petroclival Region: A Quantitative Analysis

et al. 2015

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“…The infralabyrinthine approach is particularly suited to lesions involving the posterior and inferior parts of the PA. Dearmin (1937), when first describing this approach, found that in five patients with petrous apicitis due to otitis media, cell tracts that were opened subjacent to the labyrinth led to the petrous apex. In 20 subsequent temporal bone dissections, Dearmin found that up to 4-6 mm of bone, containing air cells of the PA, invariably lay posterior and superior to the horizontal portion of the internal carotid artery.…”

Section: Discussionmentioning

confidence: 99%

“…The infralabyrinthine approach was carried out in the classical manner recommended by Dearmin (1937) and Farrior (1942). A preliminary cortical mastoidectomy was carried out by drilling through the outer cortex of the mastoid along Macewen's triangle, a triangular area bounded by the supramastoid crest superiorly, the posterosuperior wall of the external acoustic meatus anteriorly, and behind by a posterior vertical tangent to the meatal margin.…”

Section: Methodsmentioning

confidence: 99%

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Infralabyrinthine approach to the petrous apex

Jacob

Rupa

2005

Clin. Anat.

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This study measures the anatomical dimensions of the path to the petrous apex (PA) via the infralabyrinthine approach in temporal bones of adult Indian subjects, and studies the anatomical variation encountered in this approach. Forty-two temporal bones were dissected to gain access to the PA via the infralabyrinthine approach. The horizontal and vertical dimensions of the access window created as well as the length of the track to the PA from the vertical portion of facial nerve were measured with two-point calipers. Complete dissection was possible in only 21 bones (50%). In the remainder, after preliminary cortical mastoidectomy, an access window to the PA could not be created due to a high jugular bulb. The mean dimensions of the window in dissected bones were 4.60 mm vertically (SD = 0.94 mm) and 6.45 mm (SD = 1.44 mm) horizontally, and the depth of the track to the PA was 30.26 mm (SD = 3.62 mm). The infralabyrinthine approach to the PA provides wide access to lesions of the posterior and inferior PA. In up to 50% of temporal bones, as evidenced by this series, access may be limited by a high jugular bulb. The possibility of this anatomical variation should be considered when the surgical approach to a PA lesion via the infralabyrinthine approach is being planned.

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“…6,7 Also using this chain are the precochiear (Almour's operation) 8 and the subcochlear approaches 1 ' (Fig. 1).…”

Section: Suroical Approachesmentioning

confidence: 99%

Subcochlear Approach for Cholesterol Granulomas of the Inferior Petrous Apex

Ghorayeb¹,

Jahrsdoerfer²

1990

Otolaryngol.--head neck surg.

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Cholesterol granulomas of the petrous apex are drained through two major extralabyrinthine routes: one, along the posterosuperior chain of air cells, and two, along the anteroinferior chain. Procedures that use the posterosuperior chain approach the apex from the sinodural angle, the base of the zygomatic arch, the attic, or through the arch of the superior semicircular canal. Operations that use the anteroinferior chain reach the apex along the internal carotid canal (Ramadier's operation) or by a posterior infralabyrinthine approach between the descending facial nerve and jugular bulb. Inferior petrous apex cholesterol granulomas may be unreachable by any of these routes, and hence the subcochlear route is proposed as an alternative. The subcochlear approach starts in a triangle bounded superiorly by the cochlea, anteriorly by the internal carotid canal and posteriorly by the deep jugular vein. This operation requires lowering the inferior bony canal wall to the level of the "crutch." It provides access to an inferiorly situated cholesterol granuloma, yet preserves hearing. It allows enough room for the placement of a tube drain from the petrous apex to the mastoid. It is particularly useful when a high jugular bulb precludes the use of the posterior infralabyrinthine route.

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A Logical Surgical Approach to the Tip Cells of the Petrous Pyramid

Cited by 16 publications

References 3 publications

Decompression of the Jugular Bulb for Enhanced Infralabyrinthine Access to the Petroclival Region: A Quantitative Analysis

Decompression of the Jugular Bulb for Enhanced Infralabyrinthine Access to the Petroclival Region: A Quantitative Analysis

Infralabyrinthine approach to the petrous apex

Subcochlear Approach for Cholesterol Granulomas of the Inferior Petrous Apex

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