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Singal A, Sahni D, Gupta T, Aggarwal A, Gupta AK. Surgical anatomy of basal turn in relation to middle cranial fossa and round window as pertaining to middle fossa cochlear implant technique. Surg Radiol Anat 2021; 43:1195-1201. [PMID: 33399918 DOI: 10.1007/s00276-020-02647-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 12/04/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this investigation was to evaluate the relation of the basal turn of cochlea with middle cranial fossa and round window as pertaining to middle cranial fossa cochlear implant technique. METHODS Fifty-four formalin preserved temporal bones were micro-dissected to expose the basal turn. The point (f) was marked on the basal turn of cochlea where there was minimum distance of basal turn of cochlea from the floor of middle cranial fossa (f1). The f-f1 distance, the angle (∠smf) and distance of point "f" from the round window (s-f) was measured. RESULTS The mean minimum distance between basal turn of cochlea and floor of middle cranial fossa (f-f1) was 2.0 ± 0.7 mm.The point f was at mean distance (s-f) and angle (∠smf) of 14.7 ± 1.6 mm and 217° ± 13.7° from round window, respectively. CONCLUSIONS The information may be helpful for designing appropriate electrode array for middle fossa technique especially for deciding the length of electrode array towards round window, as otherwise electrode may extend into vestibule of inner ear. In the cases where bone thickness between superior part of basal turn of cochlea and middle cranial fossa is < 1.5 mm, surgeon should be extra cautious.
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Affiliation(s)
- Anjali Singal
- Department of Anatomy, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India.
| | - Daisy Sahni
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tulika Gupta
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anjali Aggarwal
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashok Kumar Gupta
- Department of Otorhinolaryngology and Head-Neck Surgery, Fortis Hospital, Mohali, Punjab, India
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Voormolen EH, Diederen S, Cebula H, Woerdeman PA, Noordmans HJ, Viergever MA, Robe PA, Froelich S, Regli L, Berkelbach van der Sprenkel JW. Distance Control and Virtual Drilling Improves Anatomical Orientation During Anterior Petrosectomy. Oper Neurosurg (Hagerstown) 2020; 18:83-91. [PMID: 31323686 PMCID: PMC7058156 DOI: 10.1093/ons/opz064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND A combined drill distance control and virtual drilling image guidance feedback method was developed. OBJECTIVE To investigate whether first-time usage of the proposed method, during anterior petrosectomy (AP), improves surgical orientation and surgical performance. The accuracy of virtual drilling and the clinical practicability of the method were also investigated. METHODS In a simulated surgical setting using human cadavers, a trial was conducted with 5 expert skull base surgeons from 3 different hospitals. They performed 10 AP approaches, using either the feedback method or standard image guidance. Damage to critical structures was assessed. Operating time, drill cavity sizes, and proximity of postoperative drill cavities to the cochlea and the acoustic meatus, were measured. Questionnaires were obtained postoperatively. Errors in the virtual drill cavities as compared with actual postoperative cavities were calculated. In a clinical setup, the method was used during AP. RESULTS Surgeons rated their intraoperative orientation significantly better with the feedback method compared with standard image guidance. During the cadaver trial, the cochlea was harmed on 1 occasion in the control group, while surgeons drilled closer to the cochlea and meatus without injuring them in the group using feedback. Virtual drilling under- and overestimation errors were 2.2 ± 0.2 and −3.0 ± 0.6 mm on average. The method functioned properly during the clinical setup. CONCLUSION The proposed feedback method improves orientation and surgical performance in an experimental setting. Errors in virtual drilling reflect spatial errors of the image guidance system. The feedback method is clinically practicable during AP.
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Affiliation(s)
- Eduard H Voormolen
- Department of Neurosurgery and Neurology, Rudolf Magnus Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Sander Diederen
- Department of Neurosurgery and Neurology, Rudolf Magnus Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Helene Cebula
- Division of Neurosurgery, University of Strasbourg, Strasbourg, France
| | - Peter A Woerdeman
- Department of Neurosurgery and Neurology, Rudolf Magnus Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Herke Jan Noordmans
- Department of Medical Technology and Clinical Physics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Max A Viergever
- Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Pierre A Robe
- Department of Neurosurgery and Neurology, Rudolf Magnus Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
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Hearing Preservation During Anterior Petrosectomy: The “Cochlear Safety Line”. World Neurosurg 2017; 99:618-622. [DOI: 10.1016/j.wneu.2016.11.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 11/01/2016] [Accepted: 11/02/2016] [Indexed: 11/19/2022]
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Lesser JCC, Brito Neto RVD, Martins GDSQ, Bento RF. Cochlear Implantation through the Middle Fossa Approach: A Review of Related Temporal Bone Studies and Reported Cases. Int Arch Otorhinolaryngol 2016; 21:102-108. [PMID: 28050216 PMCID: PMC5205528 DOI: 10.1055/s-0036-1582266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 02/16/2016] [Indexed: 10/31/2022] Open
Abstract
Introduction Middle fossa approach has been suggested as an alternative for patients in whom other routes of electrode insertion are contraindicated. Even though there are temporal bone studies about the feasibility of introducing the cochlear implant through the middle fossa, until now, very few studies have described results when cochlear implant surgery is done through this approach. Objective The objective of this study is to review a series of temporal bone studies related to cochlear implantation through the middle fossa and the results obtained by different surgical groups after cochlear implantation through this approach. Data Sources PubMed, MD consult and Ovid-SP databases. Data Synthesis A total of 8 human cadaveric temporal bone studies and 6 studies reporting cochlear implant surgery through the middle fossa approach met the inclusion criteria. Temporal bone studies show that it is feasible to perform cochlear implantation through this route. So far, only two surgical groups have performed cochlear implantation through the middle fossa with a total of 15 implanted patients. One group entered the cochlea in the most upper part of the basal turn, inserting the implant in the direction of the middle and apical turns; meanwhile, the other group inserted the implant in the apical turn directed in a retrograde fashion to the middle and basal turns. Results obtained in both groups were similar. Conclusions The middle fossa approach is a good alternative for cochlear implantation when other routes of electrode insertion are contraindicated.
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Affiliation(s)
- Juan Carlos Cisneros Lesser
- Department of Otorhinolaryngology, Hospital das Clínicas, School of Medicine, Universidade de São Paulo, HC-FMUSP, São Paulo, SP, Brazil; Department of Otorhinolaryngology, Instituto Nacional de Rehabilitación, Mexico City, Mexico
| | - Rubens Vuono de Brito Neto
- Department of Otorhinolaryngology, Hospital das Clínicas, School of Medicine, Universidade de São Paulo, HC-FMUSP, São Paulo, SP, Brazil
| | - Graziela de Souza Queiroz Martins
- Department of Otorhinolaryngology, Hospital das Clínicas, School of Medicine, Universidade de São Paulo, HC-FMUSP, São Paulo, SP, Brazil
| | - Ricardo Ferreira Bento
- Department of Otorhinolaryngology, Hospital das Clínicas, School of Medicine, Universidade de São Paulo, HC-FMUSP, São Paulo, SP, Brazil
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Alkhalili K, Tantawy M, Nageeb MM, Ragaee MA, Alshyal GH, Alcindor DS, Chen DA, Aziz KMA. Role of squamosal suture as a consistent landmark for middle fossa approach craniotomy: an anatomical study. J Neurol Surg B Skull Base 2015; 76:35-8. [PMID: 25685647 DOI: 10.1055/s-0034-1390015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 06/16/2014] [Indexed: 10/24/2022] Open
Abstract
Objective To establish a consistent surface bony landmark for a middle fossa approach (MFA) lateral craniotomy represented by the squamosal suture (SS). Methods In 60 dried skulls, we assessed the relation between the SS and the external auditory canal (EAC). The lateral portion of the middle cranial fossa floor was also assessed for a possible relation with the anteroposterior diameter (APD) of the squama temporalis (ST). Clinically, we applied our findings on the SS in MFA for different lesions. Results A vertical line at the EAC divided the ST into the anterior part constituting 61% of the APD (i.e., two thirds) and the posterior part forming 39% (i.e., one third). The average ST height was 35.92 mm. The SS posterior limit at the supramastoid crest was located just anterior to the external projection of the petrous ridge in 35 skulls (58%) and exactly corresponded to it in 25 skulls (42%). The APD of the ST equals on average 97% of the APD of the lateral middle cranial fossa. Optimum exposure of the middle fossa was obtained without any further craniotomy extension. Conclusion The SS serves as a consistent natural surface bony landmark for MFA. Optimum craniotomy, two thirds anterior to the EAC and one third posterior, is obtained following SS as a landmark.
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Affiliation(s)
- Kenan Alkhalili
- Department of Neurosurgery, Allegheny General Hospital, Drexel University College of Medicine, Pittsburgh, Pennsylvania, United States
| | - Mohammed Tantawy
- Department of Neurosurgery, Allegheny General Hospital, Drexel University College of Medicine, Pittsburgh, Pennsylvania, United States
| | - Mohab M Nageeb
- Department of Neurosurgery, Allegheny General Hospital, Drexel University College of Medicine, Pittsburgh, Pennsylvania, United States
| | - Mohamed A Ragaee
- Department of Neurosurgery, Allegheny General Hospital, Drexel University College of Medicine, Pittsburgh, Pennsylvania, United States
| | - Gasser H Alshyal
- Department of Neurosurgery, Allegheny General Hospital, Drexel University College of Medicine, Pittsburgh, Pennsylvania, United States
| | - Dunbar S Alcindor
- Department of Neurosurgery, Allegheny General Hospital, Drexel University College of Medicine, Pittsburgh, Pennsylvania, United States
| | - Douglas A Chen
- Department of Otolaryngology, Allegheny General Hospital, Drexel University College of Medicine, Pittsburgh, Pennsylvania, United States
| | - Khaled M Abdel Aziz
- Department of Neurosurgery, Allegheny General Hospital, Drexel University College of Medicine, Pittsburgh, Pennsylvania, United States
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