The Middle Fossa Approach for Removal of Small Acoustic Tumors

House, F; Hitselberger, William E.

doi:10.3109/00016486909125467

Cited by 35 publications

(8 citation statements)

References 6 publications

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“…Originally performed through the suboccipital approach, the procedure has moved to the middle fossa route introduced by W. House in 1961. 7 The retrolabyrinthine approach described by Silverstein in 1978 8 almost replaced the middle fossa and, more recently, interest has shifted again to the posterior fossa approach that has gained widespread acceptance in the last 10 years. Today, the majority of vestibular nerve sections are performed through the posterior fossa.…”

Section: Discussionmentioning

confidence: 99%

“…6 Vestibular nerve section with complete division of the eighth cranial nerve was performed by the subocciptal route in the early 1990s. The middle cranial fossa (MF) approach was described by House in 1961 7 and became the predominant route used in the 1960s and 1970s as it allowed transection of both superior and inferior vestibular nerves, leading to excellent control of vertigo. This approach, however, presents a signi cant incidence of facial weakness and deafness.…”

Section: Introductionmentioning

confidence: 99%

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Posterior fossa vestibular neurotomy as primary surgical treatment of Menière’s disease: a re-evaluation

et al. 2002

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Fifty-eight patients underwent vestibular neurotomy via the posterior fossa approach between September 1992 and December 1998 at the ENT department of Legnano. All patients presented a history of disabling unilateral Menière's disease and underwent complete neuro-otologic evaluation following the 1985 American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines. All patients underwent MRI imaging, ABR and electronystagmographic testing before surgery. Objective analysis of results is reported using the criteria published by the Committee on Hearing and Equilibrium of the AAO-HNS in 1985. According to the AAO formula, 52 patients obtained a score of 0, indicating complete control of major vertigo spells, while four were classified within the 'substantial control' group. Immediate hearing results indicated that 93 per cent of the patients maintained a level within 10 dB from the pre-operative level. Only one patient experienced a subtotal hearing loss yet retained measurable hearing. No major complications were reported. We conclude that a retrosigmoid approach to vestibular neurotomy can be considered a safe and effective procedure in relieving medically refractory vertigo in Menière's disease while preserving the hearing. Tinnitus and long-term hearing deterioration are not influenced by the procedure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Posterior fossa vestibular neurotomy as primary surgical treatment of Menière’s disease: a re-evaluation

et al. 2002

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“…House described a middle cranial fossa approach that removes supralabyrinthine cholesteatoma while maintaining serviceable hearing [9]. If hearing preservation is not feasible, a translabyrinthine approach adequately removes the lesions.…”

Section: Discussionmentioning

confidence: 99%

Hearing and Facial Function After Surgical Removal of Cholesteatomas Involving Petrous Bone

Kim

Jang

et al. 2014

Clin Exp Otorhinolaryngol

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ObjectivesThe purpose of this study was to inspect the clinical characteristics, surgical approaches, functional preservation, and complications of petrous bone cholesteatoma and to propose appropriate surgical approaches based on long-term follow-up cases and previous reports in the literature.MethodsThe medical records of 31 patients who underwent surgery for petrous bone cholesteatoma between 1990 and 2011 at two tertiary referral hospitals were retrospectively analyzed with regard to the classification, type of surgical approach, preservation of facial and auditory function, and recurrence.ResultsOf 31 cases, 16 were supralabyrinthine (class I), 1 was infralabyrinthine-apical (class III), 13 were massive (class IV), and 1 was apical (class V). Facial nerve palsy was found in 35.5% of the cases (11 cases). Hearing was preserved in 11 of 22 patients who had better than a 50-dB hearing level of bone conduction pure tone average preoperatively. Preoperative hearing was preserved in only four of the patients in class I (supralabyrinthine). Facial function was preserved or improved in 29 patients (93.5%).ConclusionComplete removal of cholesteatoma of petrous bone can be achieved by choosing the appropriate approach based on location and extent. Facial function was preserved postoperatively in most reviewed cases. Auditory function could not be preserved postoperatively in some cases, but preserving residual hearing levels can be accomplished mostly in supralabyrinthine cholesteatomas with the appropriate surgical approach.

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“…Since then, several authors [7,14,15,25,32,33] have frequently used this route for tumors of the vestibulocochlear nerve situated within the canal. Anatomic study of the structures adjacent to the 1AM have made it possible to devise extended approaches allowing excision of canal tumors extending into the CPA [1,2,21,30,38,40,42].…”

Section: Abstract : Cryosection --Mri --Cerebellopontine Angle --Micmentioning

confidence: 99%

“…In 1961, House performed [20][21][22] the first direct approach to the internal acoustic meatus (IAM) by the subtemporal extradurai route. Since then, several authors [7,14,15,25,32,33] have frequently used this route for tumors of the vestibulocochlear nerve situated within the canal.…”

Section: Abstract : Cryosection --Mri --Cerebellopontine Angle --Micmentioning

confidence: 99%

Anatomical basis of the extended subtemporal approach to the cerebellopontine angle: its value and limitations

et al. 1989

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The cerebellopontine angle is an anatomic region situated deeply at the anterolateral aspect of the brainstem, access to which is complicated by the presence of neurovascular bundles. The functional importance of these cranial n. (trigeminal, facial, vestibulo = cochlear, glossopharyngeal, vagus and accessory) calls for the use of special surgical routes of access in certain cases. In particular, tumors situated between the vestibulocochlear-facial bundle behind and the trigeminal n. in front are difficult to reach by the suboccipital and subtemporal transmeatal routes. The endeavor to preserve hearing in particular situations, where the side opposite the tumor is no longer functional, justifies the use of a subtemporal transmeatal route extended by opening the tentorium cerebelli. This anatomic and experimental surgical study deals with the possibilities of this route of approach.

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The Middle Fossa Approach for Removal of Small Acoustic Tumors

Cited by 35 publications

References 6 publications

Posterior fossa vestibular neurotomy as primary surgical treatment of Menière’s disease: a re-evaluation

Posterior fossa vestibular neurotomy as primary surgical treatment of Menière’s disease: a re-evaluation

Hearing and Facial Function After Surgical Removal of Cholesteatomas Involving Petrous Bone

Anatomical basis of the extended subtemporal approach to the cerebellopontine angle: its value and limitations

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