Role of endoscopy in lateral skull base approaches to the petrous apex

Marchioni, Daniele; Gazzini, Luca; Bonali, Marco; Bisi, Nicola; Presutti, Livio; Rubini, Alessia

doi:10.1007/s00405-019-05750-9

Cited by 11 publications

(4 citation statements)

References 17 publications

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“…With the gradual evolution of endoscopy usage in ear surgeries ( Marchioni et al., 2010a , 2010b , 2011a , 2011b , 2020 ; Tarabichi, 2004 ), exclusive endoscopic transcanal approaches have been increasingly used to address select lateral skull base lesions namely supra-geniculate fossa, cochlea, vestibule, fundus of the IAC and petrous apex. Involvement of mastoid however will require additional microscopic clearance.…”

Section: Discussionmentioning

confidence: 99%

“…Initially used to assist microscopic ear surgeries, endoscopic techniques have now replaced the microscope in many middle ear surgeries ( Marchioni et al., 2010a , 2011a , 2011b ; Tarabichi, 2004 ). With the evolution of endoscopic techniques, they are being gradually used for management of specific lateral skull base lesions ( Presutti et al., 2013 ; Marchioni et al., 2017a , 2017b , 2020 ).The endoscopic transcanal route additionally avoids any external incision using the natural corridor of external auditory canal (EAC) and significantly reduces morbidity associated with open approaches ( Marchioni et al., 2015 ).…”

Section: Introductionmentioning

confidence: 99%

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Exclusive endoscopic transcanal approach to lateral skull base lesions: Institutional experience of 3 cases

et al. 2021

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Introduction Majority of petrous bone and lateral skull base pathologies are benign in nature. The complex anatomy usually warrants an extensive approach with associated morbidity. Case summary Two cases of petrous bone cholesteatoma (1 congenital cholesteatoma with facial palsy and 1 acquired cholesteatoma) and a case of glomus tympanicum were treated with exclusive endoscopic transcanal approach. The cases of petrous cholesteatoma were addressed with trans-promontorial and infra-cochlear approaches. The mean operative time was approximately 140 min. No CSF otorrhoea was noticed in the post-operative period. The average period of hospital stay was 3.7 days. Conclusion In the subset of cases with limited benign disease an endoscopic trans-canal approach is a better alternative to an external approach. It decreases operative time, blood loss, chance of meningitis, morbidity and hospital stay. The lack of depth perception is a major hurdle which can be come over by experience in endoscopic middle ear surgery. This approach can create direct access to cochlea/petrous apex/internal auditory canal (IAC)/Supra-geniculate ganglion region.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Exclusive endoscopic transcanal approach to lateral skull base lesions: Institutional experience of 3 cases

et al. 2021

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“…With the development and improvement in endoscopic techniques, many minimally invasive otologic procedures may now be done under endoscopic visualization. This comes with the advantage of improved intraoperative visualization and significantly increased field of view, but at the disadvantage of losing binocular visualization and bimanual instrumentation in the surgical field (6)(7)(8). Endoscopicassisted resection of VS has been reported using the traditional approaches and appears noninferior to microsurgical resection in regard to facial nerve function and the extent of resection (9).…”

Section: Introductionmentioning

confidence: 99%

Endoscopic-Assisted Presigmoid Approach to the Internal Auditory Canal. A Feasibility Study

Irwin,

Lee,

Mitchell

et al. 2024

Otol Neurotol

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Hypothesis The retrolabyrinthine (presigmoid) approach has been utilized in various skull base surgeries but has not been fully utilized in the management of internal auditory canal (IAC) lesions, such as vestibular schwannoma (VS). Microsurgical retrolabyrinthine approach provides limited visualization of the IAC, while endoscopic-assisted techniques allow for further lateral exposure with labyrinthine preservation. Background Traditional approaches to the IAC have the disadvantage of hearing sacrifice or retraction of brain tissue. With the introduction of endoscopic techniques and enhanced visualization, access to this region of complex anatomy is possible. Methods Radiomorphometric and anatomical dissection was performed on two cadaveric temporal bones. High-resolution computed tomography was used to segment and delineate the volume of the IAC. Projected accessible IAC was compared to actual postdissection data with preservation of the posterior semicircular canal (PSCC) via the retrolabyrinthine corridor. Results While preserving the PSCC, the 0° and 30° endoscopes visualized 57.1% and 78.6% of the IAC for cadaver 1, and 64.0% and 76.0% of the IAC for cadaver 2, respectively. Sacrificing the PSCC, the 0° and 30° endoscopes provided visualization of 78.6% 85.7% of the IAC for cadaver 1, and 88.0% and 95.1% of the IAC for cadaver 2, respectively. Conclusions Retrolabyrinthine approach to resection of VS is a potentially viable hearing-preserving alternative to traditional approaches. This approach provides access to the majority of the IAC, while angled endoscopes or sacrifice of the PSCC can provide additional access toward the fundus. Further studies are needed to determine the clinical feasibility of this approach.

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“…The utility of endoscopic-only and endoscopic-assisted approaches to the lateral skull base has recently been established (1)(2)(3). Similar to applications in rhinology, otology, and anterior skull base surgery, endoscopy provides the lateral skull base surgeon a panoramic wide-angle field of view, high-resolution imaging, and a distal visual source enabling the surgeon to see around structures that would otherwise obstruct the direct field of view.…”

Section: Introductionmentioning

confidence: 99%

Endoscope-Assisted Visualization of the Internal Auditory Canal Using the Middle Fossa Approach

et al. 2023

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Hypothesis Angled endoscopes have been postulated to increase visualization of the internal auditory canal (IAC); however, few studies have quantified the extent of IAC visualization using endoscopes of varying angles. Background Preservation of the bony labyrinth in middle fossa (MF) vestibular schwannoma surgery may limit visualization of the lateral IAC. We sought to determine the extent to which IAC visualization is increased with endoscopes in these situations. Methods Computed tomography (CT) scans were acquired before and after two cadaveric MF bony drill-outs. An atlas-based method was used to localize the IAC in the preprocedure CT and then registered with the postprocedure CT using standard image registration methods. Virtual microscope and endoscope positions and angles of approach were determined in a 3D rendering environment. Using ray casting techniques, the percentage of IAC surface area visible (unobscured by bony structures) with the microscope and 0°, 30°, and 45° endoscopes was calculated. Results For cadaver 1, the microscope led to visible IAC surface areas of 72%, whereas 0°, 30°, and 45° endoscopes visualized 58%, 79%, and 84%, respectively. For cadaver 2, the microscope led to visible surface areas of 67%, whereas the same endoscopes visualized 66%, 84%, and 84%, respectively. Conclusions Using a microscope yields similar proportions of visible IAC surface area to a 0° endoscope in MF bony drill-outs. Increased visualization of the IAC is possible with more angled endoscopes. Using angled endoscopes may facilitate improved tumor dissection in the lateral IAC with neural and vascular preservation in vestibular schwannoma surgery aimed at hearing preservation.

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Role of endoscopy in lateral skull base approaches to the petrous apex

Cited by 11 publications

References 17 publications

Exclusive endoscopic transcanal approach to lateral skull base lesions: Institutional experience of 3 cases

Exclusive endoscopic transcanal approach to lateral skull base lesions: Institutional experience of 3 cases

Endoscopic-Assisted Presigmoid Approach to the Internal Auditory Canal. A Feasibility Study

Endoscope-Assisted Visualization of the Internal Auditory Canal Using the Middle Fossa Approach

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