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Edlinger S, Tenner E, Frühwald J, Sprinzl G. Comparison of artefact reduction possibilities with the new active transcutaneous bone conduction implant (Bonebridge). J Laryngol Otol 2023; 137:263-269. [PMID: 35144697 PMCID: PMC9975762 DOI: 10.1017/s0022215122000494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to evaluate the possibilities of artefact reduction using different anatomical implant positions with the Bonebridge bone-conduction hearing implant 602 for a patient with an acoustic neuroma requiring regular diagnostic magnetic resonance imaging of the tumour position. METHOD Three implant positions and magnetic resonance imaging examinations with and without customised sequences for metal artefact suppression were investigated. The diagnostic usefulness was rated by a radiologist (qualitative evaluation), and the relation between the area of artefact and the total head area was calculated (quantitative evaluation). RESULTS Following the qualitative analysis, the radiologist rated the superior to middle fossa implant placement significantly better for diagnostic purposes, which is in agreement with the calculated artefact ratio (p < 0.0001). The customised slice-encoding metal artifact correction view-angle tilting metal artifact reduction technique sequences significantly decreased the relative artefact area between 5.13 per cent and 25.02 per cent. The smallest mean artefact diameter was found for the superior to middle fossa position with 6.80 ± 1.30 cm (range: 5.42-9.74 cm; reduction of 18.65 per cent). CONCLUSION The application of artefact reduction sequencing and special anatomical implant positioning allows regular magnetic resonance imaging in patients with the bone-conduction hearing implant 602 without sacrificing diagnostic imaging quality for tumour diagnosis.
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Orobello N, Harrington C, Reilly BK. Updates in paediatric cholesteatoma. Curr Opin Otolaryngol Head Neck Surg 2022; 30:422-425. [PMID: 36165030 DOI: 10.1097/moo.0000000000000850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The management of paediatric patients with cholesteatoma is complex, as the disease process is more aggressive in children than adults. New technologies and practice adaptations currently help optimize the surgical management and monitoring of these challenging patients. RECENT FINDINGS Several options of surgical management are available and are associated with equal if not improved outcomes. Technologic advancements in endoscopic ear surgery, the discovery of chemical-assisted dissection of cholesteatoma and advanced imaging protocols have enabled surgeons to better care for patients with this complex disease process. SUMMARY The advances in endoscopic ear surgery, the discovery of Mesna as a chemically assisted dissection agent to improve recidivism rates and the use of specific diffusion-weighted MRI protocols enable the otologic surgeon to better care for these paediatric patients.
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Shrestha BL. Endoscopic Ear Surgery in Dhulikhel Hospital: A decade of Experience. Kathmandu Univ Med J (KUMJ) 2022; 20:518-521. [PMID: 37795735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Endoscopic ear surgery is one of the most commonly performed surgeries in Dhulikhel hospital. In the past eleven years, there have been different endoscopic ear surgeries performed with a very good outcome. The main benefit of endoscopic ear surgery is; to let the surgeon see better, proceed with the surgery through the trans-canal, teaching and training of the students. There are some drawbacks of endoscopic ear surgery like the one-handed technique and learning curve. With repeated practice and the help of motion parallax, the trainee can overcome the drawback of the procedure.
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Choi Y, Young Kwak M, Seok Kang W, Woo Chung J. Endoscopic Ear Surgery for Congenital Cholesteatoma in Children. J Int Adv Otol 2022; 18:236-242. [PMID: 35608493 PMCID: PMC10682800 DOI: 10.5152/iao.2022.21302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/04/2021] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Endoscopic ear surgery is a promising technique for removing congenital cholesteatoma in children. It can provide greater visual access to hidden areas of the middle ear and facilitate middle-ear manipulation. This study compares a single-center experience in manag- ing congenital cholesteatoma with an endoscopic approach with that in managing congenital cholesteatoma with a conventional microscopic approach. METHODS Records of consecutive patients aged under 8 with congenital cholesteatoma confined to the middle ear at our tertiary referral hospital from January 2013 to December 2018 were retrospectively reviewed. Operation time, hospital stay, postoperative complications, and recurrence/residue of congenital cholesteatoma were compared between patients receiving microscopic versus endoscopic surgery. RESULTS A total of 33 pediatric patients aged from 19 months to 7 years were enrolled; 12 children underwent microscopic surgery, and 21 received an endoscopic approach for removing congenital cholesteatoma. The mean operative time was 1.61 hours for the microscopic group and 1.49 hours for the endoscopic group without statistical difference. No postoperative sensorineural hearing loss and complications were reported. Four cases of recurrence/residue were observed on the follow-up endoscopic exam or computed tomography, and no differences were shown between the 2 groups. Of the total patients, 94.7% (n=11) in the microscopic group and 90.5% (n=19) in the endoscopic group demonstrated an intact tympanic membrane without perforation or retraction after surgery. No audiological differences were reported between the 2 groups. CONCLUSION Endoscopic ear surgery can effectively and safely remove congenital cholesteatoma in children and is not inferior to conventional microscopic approaches.
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Wu MJ, Barber SR, Chari DA, Knoll RM, Kempfle J, Lee DJ, Reinshagen KL, Remenschneider AK, Kozin ED. "Transcanal view" computed tomography reformat: Applications for transcanal endoscopic ear surgery. Am J Otolaryngol 2022; 43:103269. [PMID: 35085919 DOI: 10.1016/j.amjoto.2021.103269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 10/14/2021] [Indexed: 01/20/2023]
Abstract
PURPOSE Transcanal endoscopic ear surgery (TEES) is an increasingly used surgical approach for otologic surgeries, but no en face preoperative imaging format currently exists. We aim to assess the utility of a transcanal high resolution computed tomography (HRCT) reformat suitable for TEES preoperative planning. MATERIALS AND METHODS Preoperative HRCTs of patients with middle ear pathologies (cholesteatoma, otosclerosis, and glomus tympanicum) who underwent TEES were obtained. Axial image series were rotated and reformatted -90 or +90 degrees for left and right ear surgeries, respectively, where additional rotation along the left-right axis was performed to align the transcanal series with the plane of the external auditory canal. Quantitative measurements of middle ear structures were recorded. Consecutive transcanal reformatted sections were then reviewed to identify critical middle ear anatomy and pathology with corresponding TEES cases. RESULTS The aforementioned methodology was used to create three transcanal view HRCTs. The mean left-right axis degree of rotation was 4.0 ± 2.2 degrees. In the cholesteatoma transcanal HRCT, areas of cholesteatoma involvement in middle ear compartments (e.g. epitympanum) and eroded ossicles were successfully identified in the corresponding case. In the otosclerosis transcanal HRCT, areas for potential otosclerotic involvement were visualized such as the round window as well as a low-hanging facial nerve. In the glomus tympanicum transcanal HRCT, the span of the glomus tympanicum was successfully visualized in addition to a high riding jugular bulb. CONCLUSION A transcanal HRCT reformat may aid preoperative planning for middle ear pathologies. This novel reformat may help highlight patient-specific anatomy.
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Ogawa S, Hosoya M, Fujioka M, Ogawa K. Complete Removal of Stage II Congenital Cholesteatoma Destroying Temporomandibular Joints Using Transcanal Endoscopic Ear Surgery With a Mirror Technique: A Case Report. J Int Adv Otol 2022; 18:88-91. [PMID: 35193853 PMCID: PMC9450076 DOI: 10.5152/iao.2022.9145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Transcanal endoscopic ear surgery (TEES) provides wide-angle clear vision for otologic surgery. We report the utility of TEES with the mirror technique for the complete removal of a congenital cholesteatoma in a 3-year-old boy. A white mass was observed through the tympanic membrane, and a congenital cholesteatoma was suspected during the conservative treatment of otitis media with effusion. Pre-operative computed tomography (CT) revealed an irregular mass lesion in the left middle ear, with bone erosion in the hypotympanum. During surgery, an open-type cholesteatoma was observed, mainly in the middle lower tympanum. The cholesteatoma had destroyed the periphery of the temporomandibular joint, which was widely exposed. The cholesteatoma had also spread to the tympanic sinus. Careful observation with a forward-oblique viewing endoscope and a variable angle tympanic mirror enabled complete removal of the mass under endoscopic guidance. No recurrence was observed during the postoperative follow-up, although residual open-type congenital cholesteatoma may often result in recurrence. We believe that careful removal of the lesion under TEES, which allowed us to perform surgery under a secure view with illumination and magnification, may have facilitated complete removal and prevented recurrence.
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Jović D, Preradović L, Guzijan A. Otoplasty: a modified Chong-Chet technique with positive long-term results. Medicine (Baltimore) 2021; 100:e27554. [PMID: 34678892 PMCID: PMC8542138 DOI: 10.1097/md.0000000000027554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 09/30/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND In the last few decades, many techniques have been developed to correct prominent ear deformities. Modified Chong-Chet otoplasty represents a new and improved classical Chong-Chet procedure for prominent ear surgery. This study evaluates and compares the long-term results of standard Chong-Chet otoplasty with the modified technique. METHODS A retrospective study was conducted on patients undergoing otoplasty at the Special Hospital S-tetik Banja Luka between January 17, 2017, and February 5, 2019. The total number of patients undergoing the procedure was 129. The first group (48 patients) underwent otoplasty using the Chong-Chet technique, while the second group (81 patients) underwent a modified Chong-Chet procedure. All patients were randomly selected on the condition that the antihelix was absent.The data were processed and analyzed using the Statistical Package for the Social Sciences version 24 using nonparametric tests (χ2 test, Mann-Whitney U test and Kruskal-Wallis test). RESULTS Every second patient was satisfied (19 patients were partially satisfied and five patients were completely satisfied) with the results of the classical Chong-Chet technique. Seven patients were neither satisfied nor dissatisfied, while 17 patients were dissatisfied (11 patients were completely dissatisfied and 6 patients were mostly dissatisfied). As for the modified method, on average, nine out of 10 patients (73 or 90.1%) were satisfied, of which 49 patients (60.5%) were completely satisfied and 24 patients (29.6%) were mostly satisfied.The statistical significance was P < .05.Research results point to the modified Chong-Chet technique being a significant improvement to the classical method. CONCLUSION Modified Chong-Chet technique increases the number of positive long-term results and significantly improves the standard method.
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Komune N, Kuga D, Hashimoto K, Fujiwara Y, Shimamoto R, Nakagawa T. Subtotal temporal bone resection en bloc with the parotid gland and temporomandibular joint: a 2-dimensional operative video. Am J Otolaryngol 2021; 42:103081. [PMID: 34052059 DOI: 10.1016/j.amjoto.2021.103081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/17/2021] [Indexed: 11/19/2022]
Abstract
Primary temporal bone squamous cell carcinoma is sporadic. According to previous studies, margin-negative resection provides the best prognosis (Nakagawa et al., 2006; Moody et al., 2000; Yin et al., 2006; Komune et al., 2021 [1-4]). When tumors extend behind the tympanic membrane, lateral temporal bone resection, which is a well-established procedure, is insufficient to achieve a tumor-free margin. For these cases, subtotal temporal bone resection (STBR) can achieve a complete en bloc resection with a tumor-free margin. Furthermore, STBR en bloc with surrounding structures, including the temporomandibular joint and parotid gland, complicates surgical techniques. We previously reported this surgical procedure in a stepwise manner using cadaveric dissection (Komune et al., 2014 [5]). The STBR en bloc with the parotid gland and temporomandibular joint is composed of three approaches according to our previous report: high cervical exposure (neck dissection), a subtemporal-infratemporal fossa approach, and a retromastoid-paracondylar approach. However, we currently lack demonstrative surgical videos. According to our previous report, this video first demonstrates STBR en bloc with the parotid gland and temporomandibular joint (Komune et al., 2014 [5]). The histopathological diagnosis of a 57-year-old woman suffering from a large tumor protruding from her auricle indicated squamous cell carcinoma; after the diagnosis she was referred to our hospital. Computed tomography revealed the full extent of the tumor, which was about 8 cm in diameter and had damaged the middle cranial base, mastoid bone, and middle ear cavity. Magnetic resonance imaging indicated invasion of the glenoid fossa and parotid gland, equivalent to a Pittsburg stage cT4 tumor. The patient underwent STBR en bloc with the parotid gland and temporomandibular joint. Lower cranial nerves (CN IX-XII) were preserved, and the patient achieved normal oral intake without additional procedures after surgery. At six months post-operation, no recurrence was noted. In this video, we first demonstrate the surgical procedure of the STBR en bloc with the parotid gland and temporomandibular joint for far-advanced temporal bone squamous cell carcinoma, and it can be one of the surgical options to achieve the complete resection without exposure of the tumor. Informed consent was obtained from the patient. The video was reproduced with the written informed consent of the patient. Primary temporal bone squamous cell carcinoma is sporadic. According to previous studies, margin-negative resection provides the best prognosis (Nakagawa et al., 2006; Moody et al., 2000; Yin et al., 2006; Komune et al., 2021 [1-4]). When tumors extend behind the tympanic membrane, lateral temporal bone resection, which is a well-established procedure, is insufficient to achieve a tumor-free margin. For these cases, subtotal temporal bone resection (STBR) can achieve a complete en bloc resection with a tumor-free margin. Furthermore, STBR en bloc with surrounding structures, including the temporomandibular joint and parotid gland, complicates surgical techniques. We previously reported this surgical procedure in a stepwise manner using cadaveric dissection (Komune et al., 2014 [5]). The STBR en bloc with the parotid gland and temporomandibular joint is composed of three approaches according to our previous report: high cervical exposure (neck dissection), a subtemporal-infratemporal fossa approach, and a retromastoid-paracondylar approach. However, we currently lack demonstrative surgical videos. According to our previous report, this video first demonstrates STBR en bloc with the parotid gland and temporomandibular joint (Komune et al., 2014 [5]). The histopathological diagnosis of a 57-year-old woman suffering from a large tumor protruding from her auricle indicated squamous cell carcinoma; after the diagnosis she was referred to our hospital. Computed tomography revealed the full extent of the tumor, which was about 8 cm in diameter and had damaged the middle cranial base, mastoid bone, and middle ear cavity. Magnetic resonance imaging indicated invasion of the glenoid fossa and parotid gland, equivalent to a Pittsburg stage cT4 tumor. The patient underwent STBR en bloc with the parotid gland and temporomandibular joint. Lower cranial nerves (CN IX-XII) were preserved, and the patient achieved normal oral intake without additional procedures after surgery. At six months post-operation, no recurrence was noted. In this video, we first demonstrate the surgical procedure of the STBR en bloc with the parotid gland and temporomandibular joint for far-advanced temporal bone squamous cell carcinoma, and it can be one of the surgical options to achieve the complete resection without exposure of the tumor. Informed consent was obtained from the patient. The video was reproduced with the written informed consent of the patient.
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Zobeiri OA, Mischler GM, King SA, Lewis RF, Cullen KE. Effects of vestibular neurectomy and neural compensation on head movements in patients undergoing vestibular schwannoma resection. Sci Rep 2021; 11:517. [PMID: 33436776 PMCID: PMC7804855 DOI: 10.1038/s41598-020-79756-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 12/07/2020] [Indexed: 01/29/2023] Open
Abstract
The vestibular system is vital for maintaining balance and stabilizing gaze and vestibular damage causes impaired postural and gaze control. Here we examined the effects of vestibular loss and subsequent compensation on head motion kinematics during voluntary behavior. Head movements were measured in vestibular schwannoma patients before, and then 6 weeks and 6 months after surgical tumor removal, requiring sectioning of the involved vestibular nerve (vestibular neurectomy). Head movements were recorded in six dimensions using a small head-mounted sensor while patients performed the Functional Gait Assessment (FGA). Kinematic measures differed between patients (at all three time points) and normal subjects on several challenging FGA tasks, indicating that vestibular damage (caused by the tumor or neurectomy) alters head movements in a manner that is not normalized by central compensation. Kinematics measured at different time points relative to vestibular neurectomy differed substantially between pre-operative and 6-week post-operative states but changed little between 6-week and > 6-month post-operative states, demonstrating that compensation affecting head kinematics is relatively rapid. Our results indicate that quantifying head kinematics during self-generated gait tasks provides valuable information about vestibular damage and compensation, suggesting that early changes in patient head motion strategy may be maladaptive for long-term vestibular compensation.
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Panda A, Carlson ML, Diehn FE, Lane JI. Beyond Tympanomastoidectomy: A Review of Less Common Postoperative Temporal Bone CT Findings. AJNR Am J Neuroradiol 2021; 42:12-21. [PMID: 33184072 PMCID: PMC7814786 DOI: 10.3174/ajnr.a6802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/18/2020] [Indexed: 11/07/2022]
Abstract
Postoperative temporal bone imaging after surgical procedures such as ossiculoplasty, tympanomastoidectomy, cochlear implantation, and vestibular schwannoma resection is often encountered in clinical neuroradiology practice. Less common otologic procedures can present diagnostic dilemmas, particularly if access to prior operative reports is not possible. Lack of familiarity with the less common surgical procedures and expected postoperative changes may render radiologic interpretation challenging. This review illustrates key imaging findings after surgery for Ménière disease, superior semicircular canal dehiscence, temporal encephalocele repairs, internal auditory canal decompression, active middle ear implants, jugular bulb and sigmoid sinus dehiscence repair, and petrous apicectomy.
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Abstract
Pediatric chronic ear disease and its sequelae often necessitate surgical intervention, such as ear tube insertion, ossiculoplasty, tympanoplasty, and cholesteatoma removal. Although these procedures have traditionally been performed with the microscope, use of rigid endoscopes provides an alternative method for visualization. The endoscope offers improved visualization of the middle ear space and adjacent structures and can either be used alone to perform surgery through the ear canal or together with the microscope if mastoidectomy is required. Endoscopic ear surgery can reduce the need for a postauricular incision or mastoidectomy while resulting in equivalent hearing outcomes compared with those performed with the microscope. In addition, use of the endoscope is associated with lower rates of residual disease following primary cholesteatoma procedures.
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Al Tamami N, Bawazeer N, Fieux M, Zaouche S, Tringali S. Tolerance and safety of 45S5 bioactive glass used in obliteration procedures during middle ear surgery: Preliminary results. Am J Otolaryngol 2020; 41:102542. [PMID: 32620365 DOI: 10.1016/j.amjoto.2020.102542] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 04/29/2020] [Accepted: 05/03/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Otologists face many disadvantages after extensive mastoid drilling and canal wall down technique in cholesteatoma surgery. Mastoid and epitympanic cavity obliterations or reconstructions after canal wall down procedure using bioactive glass seem to be an interesting solution to overcome some of these disadvantages. Bioactive glass offers many benefits including the availability when there are no sufficient autologous materials for obliteration, its antibacterial activity in chronic infected ear and decreasing the recidivism of cholesteatoma. The objective of this study is to evaluate the tolerance and safety of 45S5 bioactive glass as a filing bone-synthetic material by clinical, audiological and radiological examinations. METHODOLOGY A retrospective study of 42 patients who had undergone obliteration of mastoid or/and epitympanic cavity with 45S5 bioactive glass between, November 2017 to January 2019. Data from clinical follow-ups, audiological assessment, CT-scan and MRI were analyzed. RESULT The patients' mean age was 49.8 years old. Microscopic examinations showed dry well-healed tympanic membranes and external auditory canals for 95.2% of the patients after 1 year. Inner ear injuries after obliteration were not observed by comparing pre and post-operative bone conduction audiometry (p value 0.457). No facial palsy was reported post-operatively. One-year postoperative radiological assessments did not reveal any silent implantation of cholesteatoma or residual disease. CONCLUSION Mastoid and epitympanic obliterations with 45S5 bioactive glass seem to be a tolerable and safe option in cholesteatoma surgery with favorable outcomes similar to other member of bioactive glass especially the S53P4.
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Kaul VF, Filip P, Schwam ZG, Wanna GB. Nuances in transcanal endoscopic surgical technique for glomus tympanicum tumors. Am J Otolaryngol 2020; 41:102562. [PMID: 32563784 DOI: 10.1016/j.amjoto.2020.102562] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/24/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe the utility and nuances of transcanal endoscopic surgery (TCES) on glomus tympanicum tumors from a single surgeon's experience. PATIENTS/INTERVENTION Twelve patients, eight female and four males, diagnosed pre-operatively with glomus tympanicum tumors. They all underwent endoscopic resection by a single surgeon. MAIN OUTCOME MEASURES Feasibility of endoscopic resection of glomus tympanicum tumors without conversion to a microscopic approach. Secondary outcomes include tumor stage, pre and post-operative audiometry, vertigo, sensorineural hearing loss (SNHL) and integrity of the facial nerve, ossicles, chorda tympani and tympanic membrane. RESULTS Twelve patients underwent TCES, eight patient's pathology results were glomus tympanicum, ranging from Glasscock-Jackson grade I-III. Due to loss in follow up, 6/8 patients had complete audiometric data, which were analyzed. Average pre-operative air-bone-gap (ABG) was 5.41 compared to post-operative ABG of 5.08 (p > 0.89). No patients resulted in any, post-operative vertigo, tinnitus, SNHL, facial nerve injury or chorda tympani nerve injury. Two patients had intentional tympanic membrane perforations secondary to tumor adherence to the membrane. They were repaired with tragal perichondrium graft. No patients have had any recurrences. CONCLUSIONS Endoscopic resection of glomus tympanicum tumors is a feasible and effective, alternative visualization modality for the neurotologist. Surgical pearls are described herein.
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Merati M, Kazemi MA, Dabiri S, Kouhi A. Radiologic evaluation of the mastoid segment of the facial nerve tract in the intact temporal bone. Surg Radiol Anat 2020; 43:145-151. [PMID: 32809103 DOI: 10.1007/s00276-020-02554-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 08/14/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To localize the facial nerve course in the mastoid segment and to measure its distances relative to the tympanic membrane. METHODS This is a cross-sectional descriptive study. During 2019 in a tertiary hospital, 129 non-contrast and non-pathologic temporal CT images were studied in a tertiary hospital. Facial nerve distances were measured from the planes passing through the annulus in the axial cross-sections at superior, umbo, and inferior levels of the tympanic membrane. It was done in two different dimensions which are anteroposterior (toward the plane of the ear canal wall) and mediolateral (toward the plane of the tympanic membrane). RESULTS The least mean anteroposterior distance between the facial nerve and the posterior ear canal wall was at the level of umbo (3.66 ± 0.76 mm). The nearest point of the nerve toward the tympanic membrane was the inferior level (- 0.03 ± 0.81 mm). Overall external ear canal lengths were statistically significantly lower in women rather than men. There was a reverse correlation between the age and the ear canal length. CONCLUSION Posterior canalplasty seems to be safe unless dissection does not cross the plane of annulus. In this study, the safe margin was 1.4 mm in posterior canal wall drilling. It also should be performed carefully if it extends to the inferior side of the canal. Measuring the mediolateral dimension of the nerve toward the annulus in the axial CT images seems to be practically beneficial, especially in the inferior where the ear canal wall turns and might not act as a good landmark. Paying attention to this plane may reduce the risks of nerve injury in any procedures with transcanal approaches, particularly in inferior canaloplasty.
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Paradiso MM, Kaffenberger BH, Rock AN, Dodson EE. Optimizing Management of Otophyma: A Case Series Highlighting the Role of Surgical and Retinoid Therapy. EAR, NOSE & THROAT JOURNAL 2020; 100:253S-258S. [PMID: 32804571 DOI: 10.1177/0145561320947619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Otophyma is a rare condition that can result in conductive hearing loss. Current otophyma literature does not examine validated treatment outcomes for patients. Utilizing a medical and surgical approach to maintain a patent canal can lead to significant objective improvements. The aim of this case series is to describe a combined successful approach in 3 cases from an academic, multidisciplinary center. The main outcomes analyzed were pre and post air-bone gap audiogram analysis and disimpaction frequency. The results showed that post-management, patient 1 had substantial improvement in hearing, recovering 49 dB in his right ear and 25 dB in his left ear, demonstrating near complete air-bone gap closure. Patient 2 showed a similar dermatologic and functional improvement, although objective audiometric assessment related to otophyma could not be performed due to coexisting chronic otitis media and cholesteatoma. Patient 3, in the 12 months prior to comanagement, had 8 bilateral disimpactions, and following comanagement had 2 disimpactions in 23 months. All 3 patients were pleased with the resultant functional and physical appearance following comanagement. By presenting this approach and objective measures of treatment, we hope to improve future clinical decision-making in a rare condition.
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Lee KH, Lee SM, Kim SW, Park KJ, Lee JH. Minimization of skin incision at preauricular sinusectomy using a trans pit approach. Int J Pediatr Otorhinolaryngol 2020; 132:109903. [PMID: 32014737 DOI: 10.1016/j.ijporl.2020.109903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/07/2019] [Accepted: 01/20/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND We introduced a surgical procedure which includes a simple sinusectomy without opening the sinus whilst attempting to minimize the skin incision. METHODS A total of 34 patients with preauricular sinus were treated. In six patients, this technique was performed bilaterally, so a total of 40 ears were enrolled and analyzed for recurrence rate and surgical outcome in retrospective observational study. A database was created which included patient age, the preoperative and postoperative incision size, suture materials used, and complications. Incisional size according to the previous infection condition and incision and drainage (I & D) history were analyzed. RESULTS The mean initial skin incision length was 0.75 ± 0.40 cm and mean incision length after skin suture was 0.81 ± 0.42 cm. The young group under 10 years of age had a mean initial skin incision length of 0.56 ± 0.06 cm, and mean incision length after skin suture was 0.58 ± 0.08 cm. Suture materials were Nylon 6-0 for 14 ears, Nylon 7-0 for 20 ears, and Nylon 8-0 for 6 ears. The incidence of minor complications (immediate wound dehiscence, wound opening at a previous I & D region, keloid formation) was 7.5%. CONCLUSION Our method overcomes potential problems with esthetics in addition to reducing the recurrence rates of preauricular sinusectomy. With our technique, minimization of skin incision length is possible without the risk of recurrence. The use of fine suture materials and not using drainage avoids additional skin trauma.
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Singh A, Thakur R, Kumar R, Verma H, Irugu DVK. Grading of the Position of the Mastoid Tegmen in Human Temporal Bones - A Surgeon's Perspective. J Int Adv Otol 2020; 16:63-66. [PMID: 32401204 PMCID: PMC7224437 DOI: 10.5152/iao.2020.7748] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/18/2019] [Accepted: 12/13/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To establish a new surgically relevant classification system of the anatomic variations of the temporal bone tegmen plate as well as to perform a comparative analysis, with respect to the pneumatization patterns in the cadaveric temporal bones. MATERIALS AND METHODS Microdissection of the human cadaveric temporal bones was performed after obtaining ethical approval from the Institutional Ethical Committee (F.8-522/A-522/2017/RS). The pneumatization pattern of the temporal bones was noted as "under-pneumatized" or "well-pneumatized." The tegmen mastoid (TM) was classified into two grades as per the position of the tegmen plate and the visibility of the superior semicircular canal (SSCC) and the aditus. The latter two structures were well visualized in Grade A and poorly visualized in Grade B. The data were analyzed using Stata 14.0 (Stata Corp, 4905, Lakway drive, College Station, Texas, USA). RESULTS Ninety-three temporal bones were dissected under microscope. Fifty-eight bones were well-pneumatized and 35 were under-pneumatized. The tegmen plates were classified as Grade-A in 49 bones (well-pneumatized -37 and under-pneumatized -12), and as Grade-B in 44 bones (well-pneumatized-21, poorly-pneumatized-23). Grade-A classification was significantly more common in well-pneumatized temporal bones, while Grade-B was more common in under-pneumatized bones (p=0.0057). CONCLUSION We propose a surgically relevant classification for TM positioning. A well-pneumatized temporal bone is associated with a significantly higher position of the tegmen plate (Grade-A TM).
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Park HS, Choi JW. Combined surgical approach to intralabyrinthine schwannoma. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 137:223-226. [PMID: 31208878 DOI: 10.1016/j.anorl.2018.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 09/11/2018] [Accepted: 09/27/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Intralabyrinthine schwannoma (ILS) is a tumor originating from the Schwann cells in the inner ear. Various surgical approaches can be used for the resection of ILS. The aim of this report is to describe a case involving a 60-year-old man who was treated successfully with a combined surgical approach. CASE REPORT The patient underwent a combined microscopic (transmastoid labyrinthectomy) and endoscopic procedure for surgical excision of ILS involving the vestibule and the lower half of the cochlear basal turn. The combined surgical technique enabled a complete removal of the ILS without removal of the unaffected cochlea as well as the external auditory canal. Besides additional exclusion of the middle ear, blind-sac closure of the external auditory canal and cavity obliteration were avoided. No postoperative complications were observed. DISCUSSION A combined microscopic and endoscopic approach to surgery enables removal of the ILS involving the vestibule and the lower half of the cochlear basal turn while helping to reduce surgical radicality.
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Ochal-Choińska A, Lachowska M, Kurczak K, Niemczyk K. Audiologic prognostic factors for hearing preservation following vestibular schwannoma surgery. ADV CLIN EXP MED 2019; 28:747-757. [PMID: 30784239 DOI: 10.17219/acem/90768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Postoperative hearing loss after vestibular schwannoma (VS) removal still remains a lifelong problem for the patients. The present study analyzes the problem of hearing preservation after VS removal from a different angle than available professional literature on this topic. OBJECTIVES To identify audiologic factors which determine the extent of hearing loss in patients operated on for VS. MATERIAL AND METHODS The study group included 86 patients operated on due to VS accessed via the middle cranial fossa. The analyses involved the effect on absolute hearing loss, which was calculated on the basis of the results of pure-tone audiometry performed preand postoperatively, and factors included in the preoperative audiologic tests, such as pure-tone audiometry, speech audiometry, auditory brainstem response (ABR), and impedance audiometry. RESULTS The following parameters were demonstrated to have a prognostic value: 1. hearing thresholds at 125 Hz, 500 Hz and 1,000 Hz for the operated ear, Pure Tone Average (PTA) - calculated specifically at 500 Hz, 1,000 Hz and 2,000 Hz and at 500 Hz, 1,000 Hz, 2,000 Hz, and 4,000 Hz for the operated ear, and normal audiometric curve; 2. speech discrimination ranging from 55 dB to 75 dB for the operated ear, speech detection threshold (SDT) in the operated ear and interaural difference at 25-35 dB (non-operated vs operated ear); 3. presence of wave V, the values of I-V and III-V intervals for the operated ear, the amplitude of wave V, and the interaural ratio of wave V amplitudes; 4. intensity level for obtaining stapedial reflex or an abnormal reflex at Ipsi 500 Hz, 1,000 Hz and 2,000 Hz, and Contra 500 Hz, 1,000 Hz, 2,000 Hz, and 4,000 Hz. CONCLUSIONS The better the preoperative hearing status, the more substantial surgery-related hearing loss was observed. A number of preoperative parameters of the basic diagnostic set of audiologic tests present a prognostic value for the degree of surgery-related hearing loss in VS patients.
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Banakis Hartl RM, Said S, Mann SE. Bilateral Ear Canal Cholesteatoma with Underlying Type I First Branchial Cleft Anomalies. Ann Otol Rhinol Laryngol 2019; 128:360-364. [PMID: 30607978 PMCID: PMC11123599 DOI: 10.1177/0003489418821700] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES: To describe a case of bilateral ear canal cholesteatomas in the setting of underlying first branchial cleft cyst anomalies and to review the pathophysiology underlying the development of external auditory canal cholesteatomas from branchial cleft cyst abnormalities. METHODS AND RESULTS: We present a case study of a 61-year-old man who presented with chronic right-sided hearing loss and left-sided postauricular drainage. Clinical evaluation, radiographic work-up, and pathologic analysis confirmed a diagnosis of bilateral ear canal cholesteatoma in the setting of underlying first branchial cleft cyst anomalies. The patient's clinical course, surgical treatment, and management considerations are discussed here. CONCLUSION: Ear canal cholesteatoma represents a rare clinical disease entity deserving a thorough initial assessment. Careful consideration of underlying diseases that result in chronic inflammation, such as branchial cleft lesions, should be included in the differential diagnosis of idiopathic canal cholesteatoma in the absence of prior otologic surgery or trauma.
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Silverstein H, Smith J, Kellermeyer B. Stapes hypermobility as a possible cause of hyperacusis. Am J Otolaryngol 2019; 40:247-252. [PMID: 30502003 DOI: 10.1016/j.amjoto.2018.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 10/30/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Hyperacusis is a reduction of normal tolerances for everyday sounds. Although several publications have been produced demonstrating that minimally invasive surgical procedures may improve patient symptoms, the precise etiology of hyperacusis often remains elusive. This study describes 21 patients, 7 of whom stapes hypermobility is believed to be a mechanical genesis of their hyperacusis symptoms. STUDY DESIGN A prospective, repeated-measure single-arm design was used for this study. SETTING All patients were evaluated and treated at a tertiary level otologic referral center. SUBJECTS AND METHODS 21 patients (Cohort A) with severe hyperacusis underwent oval and round window reinforcement. Seven patients (Cohort B) intraoperatively appeared to have subjective hypermobility of the stapes. Additional reinforcement of the stapes superstructure was performed in these patients. RESULTS In Cohort A, loudness discomfort level (LDL) values improved on average from 72.7 dB to 81.9 dB. Hyperacusis questionnaire (HQ) scores improved from 30.1 to 14.7. Numeric Rating Scale scores (0-10) decreased from 8.5 to 4.0. In Cohort B, values similarly improved from an average of 72.4 dB to 88.2 dB. HQ scores improved from 35.8 to 18.9. Numeric Rating Scale scores fell from 10.0 to 3.7. Postoperatively there were no complaints of hearing loss. Sixteen out of 21(76%) reported improved quality of life and diminished symptoms of hyperacusis. CONCLUSION It is possible that patients suffering from hyperacusis may have a mechanical cause for their symptoms. Further research is necessary to clarify stapes mobility in patients with these symptoms. Excess temporalis tissue reinforcement of the stapes along with round window reinforcement shows promise as a minimally invasive surgical option for patients suffering from hyperacusis.
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Hardin FM, Xiao R, Burkey BB. Surgical management of patients with Eagle syndrome. Am J Otolaryngol 2018; 39:481-484. [PMID: 29764674 DOI: 10.1016/j.amjoto.2018.05.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 05/09/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Eagle syndrome, a spectrum of disease resulting from an elongated styloid process and/or calcified stylohyoid ligament, lacks standardized recommendations regarding indications for surgical intervention and approach. STUDY DESIGN Retrospective cohort study. SETTING Single tertiary care institution. SUBJECTS Patients treated surgically for Eagle syndrome between January 2011 and June 2017. METHODS Patients were diagnosed with Eagle syndrome based on thorough clinical workup and assessment. The primary outcome was improvement in pain severity following surgery, with complete resolution of pain being considered clinically meaningful. Wilcoxon rank-sum tests and Fisher's exact were used to compare numerical and categorical variables, respectively. RESULTS Twenty-one patients were diagnosed with Eagle syndrome and underwent surgical resection of the styloid process. Patients most often complained of neck pain (81%), throat pain (62%), and ear pain (48%). Among these patients, 57% of procedures featured a transcervical approach, while the remaining 43% were transoral. The vast majority (90%) of patients experienced improvement in pain severity from a median of 6.0 before surgery to 0.0 afterwards (p < 0.01) as 62% experienced complete resolution. Using multivariable linear regression to model changes in pain severity, neck pain (β = -1.69, p < 0.01) and jaw pain (β = -0.93, p = 0.03) predicted greater relief, while headache (β = 0.82, p = 0.04) predicted an inferior response. Adverse events were uncommon and typically resolved within three months, with 24% experiencing first bite syndrome and 19% reporting numbness. CONCLUSIONS Transcervical and transoral styloidectomy are effective treatments for Eagle syndrome with minimal adverse effects. Patients with classic symptoms of neck or jaw pain benefit most from surgery.
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Abstract
Acoustic neuromas, also known as vestibular schwannomas, are slow-growing, benign tumors that develop on the eighth cranial nerve. Common signs and symptoms of an acoustic neuroma include hearing loss and balance disturbances. A physical examination, a hearing evaluation, and diagnostic imaging assist in the diagnosis of an acoustic neuroma. Patients with a confirmed tumor have three treatment options: observation, stereotactic radiosurgery, and surgical removal. Complications include cerebrospinal fluid leakage, damage to ancillary brain structures, facial nerve damage, and bleeding or vascular injury. This article focuses on the surgical removal of an acoustic neuroma and the role of the perioperative nurse in the perioperative care of the patient.
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Nguyen T, Lagman C, Sheppard JP, Romiyo P, Duong C, Prashant GN, Gopen Q, Yang I. Middle cranial fossa approach for the repair of superior semicircular canal dehiscence is associated with greater symptom resolution compared to transmastoid approach. Acta Neurochir (Wien) 2018; 160:1219-1224. [PMID: 29022108 DOI: 10.1007/s00701-017-3346-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 09/29/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Superior semicircular canal dehiscence (SSCD) is a disorder of the skull base that is gaining increasing recognition among neurosurgeons. Traditionally, the middle cranial fossa (MCF) approach has been used for the surgical repair of SSCD. However, the transmastoid (TM) approach is an alternative strategy that has demonstrated promising results. METHODS We performed independent searches of a popular database to identify studies that described outcomes following the surgical repair of SSCD through MCF and TM approaches. The primary outcome was symptom resolution. RESULTS Our analysis included 24 studies that described 230 patients that underwent either an MCF (n = 148, 64%) approach or a TM (n = 82, 36%) approach for primary surgical repair of SSCD. A greater percentage of patients in the MCF group experienced resolution of auditory symptoms (72% vs 59%, p = 0.012), aural fullness (83% vs 55%, p = 0.049), hearing loss (57% vs 31%, p = 0.026), and disequilibrium (75% vs 44%, p = 0.001) when compared to the TM group. The MCF approach was also associated with higher odds of symptom resolution for auditory symptoms (odds ratio [OR] 1.79, 95% confidence interval [CI] 1.14-2.82), aural fullness (OR 4.02, 95% CI 1.04-15.53), hearing loss (OR 2.91, 95% CI 1.14-7.42), and disequilibrium (OR 3.94, 95% CI 1.78-8.73). The mean follow-up was 9 months. CONCLUSIONS The literature suggests that the MCF approach for the repair of SSCD is associated with greater symptom resolution when compared to the TM approach. This information could help facilitate patient discussions.
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Wang S, Qin Y, Xiao D, Wu Z, Wei L. Imaging Evaluation of the Location and Fenestration of Sellar Floor During Endonasal Transsphenoidal Surgery in Patients with Pituitary Adenomas. World Neurosurg 2018; 116:e232-e238. [PMID: 29730106 DOI: 10.1016/j.wneu.2018.04.178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 04/23/2018] [Accepted: 04/24/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate clinical value of three-dimensional (3D) computed tomography (CT) reconstruction of the sphenoid sinus separation in localizing sellar floor during endonasal transsphenoidal surgery and determine size and location of sellar floor fenestration. METHODS There were 51 patients eligible for study inclusion. Preoperative CT scan of the paranasal sinus and CT scan and magnetic resonance imaging of the pituitary gland were obtained. Sphenoid sinus separation was reconstructed using Mimics 15.0 software, and quantity, shape, and orientation were observed and compared with intraoperative data to guide the localization of sellar floor. Anatomic variation of the sphenoid sinus and adjacent structures, tumor and sella turcica morphology, minimal distance between the cavernous segment of the internal carotid artery bilaterally, and shortest distance from the midline were measured. RESULTS Based on the shape of the sphenoid sinus separation, sellar floor was accurately localized in all cases. Intraoperative sphenoid sinus separation was consistent with preoperative three-dimensional CT reconstruction images. The sellar floor was extremely small in 2 patients, and insufficient fenestration of sellar floor negatively affected tumor resection. Preoperative three-dimensional CT reconstruction is helpful for accurate and rapid localization of sellar floor. CONCLUSIONS Anatomic variation of sphenoid sinus and adjacent structures, characteristics of tumor and sella, minimum distance between bilateral cavernous segment of the internal carotid artery, and shortest distance from midline are helpful for establishment of individualized sellar floor fenestration.
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