Middle fossa approach for a pediatric facial nerve meningioma

Rennert, Robert C.; Levy, Danielle; Plonsker, Jillian; Steinberg, Jeffrey A.; Friedman, Rick A.; Crawford, John R.; Levy, Michael L.

doi:10.3171/2020.5.peds2034

Cited by 2 publications

(2 citation statements)

References 16 publications

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“…The predominately open conical shape and largely preserved volume of the IAC in younger patients may nonetheless aid visualization of the proximal IAC despite these constraints. Accordingly, in our experience the safe performance of these approaches is possible, even in patients less than 2 years old 27 , 31 .…”

Section: Discussionmentioning

confidence: 71%

“…In adults, numerous cadaveric and radiographic studies have defined the anatomic dimensions and variability of this region, including the size and shape of the IAC 2 , 9 – 15 , as well as the distance of the IAC to surgically relevant inner ear structures such as the posterior semicircular canal (PSC), vestibule, and common crus (CC) 2 , 3 , 13 . Descriptions of these parameters in children are nonetheless limited 16 , 17 , despite other known differences in skull base anatomy between children and adults 18 – 23 , and an increasing application of skull base approaches in pediatric patients 18 , 19 , 24 – 31 . We herein perform a granular analysis of the IAC and surgically relevant parameters of the posterior petrous bone during normal pediatric maturation.…”

Section: Introductionmentioning

confidence: 99%

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Maturation of the internal auditory canal and posterior petrous bone with relevance to lateral and posterolateral skull base approaches

Rennert

Brandel

Steinberg

et al. 2022

Sci Rep

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Anatomic knowledge of the internal auditory canal (IAC) and surrounding structures is a prerequisite for performing skull base approaches to the IAC. We herein perform a morphometric analysis of the IAC and surgically relevant aspects of the posterior petrous bone during pediatric maturation, a region well-studied in adults but not children. Measurements of IAC length (IAC-L), porus (IAC-D) and midpoint (IAC-DM) diameter, and distance from the porus to the common crus (CC; P-CC) and posterior petrosal surface (PPS) to the posterior semicircular canal (PSC; PPS-PSC) were made on thin-cut axial CT scans from 60 patients (grouped by ages 0–3, 4–7, 8–11 12–15, 16–18, and > 18 years). IAC-L increased 27.5% from 8.7 ± 1.1 at age 0–3 to 11.1 ± 1.1 mm at adulthood (p = 0.001), with the majority of growth occurring by ages 8–11. IAC-D (p = 0.52) and IAC-DM (p = 0.167) did not significantly change from ages 0–3 to adult. P-CC increased 31.1% from 7.7 ± 1.5 at age 0–3 to 10.1 ± 1.5 mm at adulthood (p = 0.019). PPS-PSC increased 160% from 1.5 ± 0.7 at age 0–3 to 3.9 ± 1.2 mm at adulthood (p < 0.001). The majority of growth in P-CC and PPS-PSC occurred by ages 12–15. Knowledge of these patterns may facilitate safe exposure of the IAC in children.

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Section: Discussionmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Maturation of the internal auditory canal and posterior petrous bone with relevance to lateral and posterolateral skull base approaches

Rennert

Brandel

Steinberg

et al. 2022

Sci Rep

Self Cite

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Maturation of the anterior petrous apex: surgical relevance for performance of the middle fossa transpetrosal approach in pediatric patients

Rennert

Brandel

Steinberg

et al. 2022

Journal of Neurosurgery

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OBJECTIVE The middle fossa transpetrosal approach to the petroclival and posterior cavernous sinus regions includes removal of the anterior petrous apex (APA), an area well studied in adults but not in children. To this end, the authors performed a morphometric analysis of the APA region during pediatric maturation. METHODS Measurements of the distance from the clivus to the internal auditory canal (IAC; C-IAC), the distance of the petrous segment of the internal carotid artery (petrous carotid; PC) to the mesial petrous bone (MPB; PC-MPB), the distance of the PC to the mesial petrous apex (MPA; PC-MPA), and the IAC depth from the middle fossa floor (IAC-D) were made on thin-cut CT scans from 60 patients (distributed across ages 0–3, 4–7, 8–11, 12–15, 16–18, and > 18 years). The APA volume was calculated as a cylinder using C-IAC (length) and PC-MPB (diameter). APA pneumatization was noted. Data were analyzed by laterality, sex, and age. RESULTS APA parameters did not differ by laterality or sex. APA pneumatization was seen on 20 of 60 scans (33.3%) in patients ≥ 4 years. The majority of the APA region growth occurred by ages 8–11 years, with PC-MPA and PC-MPB increasing 15.9% (from 9.4 to 10.9 mm, p = 0.08) and 23.5% (from 8.9 to 11.0 mm, p < 0.01) between ages 0–3 and 8–11 years, and C-IAC increasing 20.7% (from 13.0 to 15.7 mm, p < 0.01) between ages 0–3 and 4–7 years. APA volume increased 79.6% from ages 0–3 to 8–11 years (from 834.3 to 1499.2 mm3, p < 0.01). None of these parameters displayed further significant growth. Finally, IAC-D increased 51.1% (from 4.3 to 6.5 mm, p < 0.01) between ages 0–3 and adult, without significant differences between successive age groups. CONCLUSIONS APA development is largely complete by the ages of 8–11 years. Knowledge of APA growth patterns may aid approach selection and APA removal in pediatric patients.

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Middle fossa approach for a pediatric facial nerve meningioma

Cited by 2 publications

References 16 publications

Maturation of the internal auditory canal and posterior petrous bone with relevance to lateral and posterolateral skull base approaches

Maturation of the internal auditory canal and posterior petrous bone with relevance to lateral and posterolateral skull base approaches

Maturation of the anterior petrous apex: surgical relevance for performance of the middle fossa transpetrosal approach in pediatric patients

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