Maximizing Exposure of the Internal Auditory Canal Via the Retrosigmoid Approach: An Anatomical, Radiological, and Surgical Study. 2018

Roberto A Cueva, and Richard A Chole
Department of Head and Neck Surgery, Southern California Permanente Medical Group, San Diego, California.

The purpose of this study was to identify anatomic landmarks and surgical techniques that maximize bone removal for exposure of the distal internal auditory canal (IAC) to avoid labyrinthine injury during retrosigmoid removal of tumors within the IAC. Anatomic dissection, radiological assessment and retrospective case series. Tertiary referral center. On the basis of previously conducted temporal bone anatomic dissections of the temporal bone, the authors performed intraoperative measurement of the undissected distal IAC, performed pre- and postoperative radiological assessment of vestibular schwannoma (VS) patients. The surgical and anatomic information was used to determine the anatomic limits of labyrinth sparing bone dissection and the landmarks most critical to maximal IAC exposure. The authors describe surgical techniques using these data. An edited video of representative surgery highlights important principles. Review of 251 patients requiring IAC bony dissection for tumor removal from January 2005 through October 2017 is described. Achieving complete exposure of the IAC fundus is not possible, without labyrinthine injury, via retrosigmoid approach. Anatomic dissection, intraoperative photography, and postoperative radiographs demonstrate that bone removal within 2 to 3 mm of the fundus is routinely possible. The endolymphatic sac and duct is the optimal landmark for optimizing IAC exposure. The course of the endolymphatic sac and duct in the posterior petrous bone is the most important landmark determining the lateral limit of bony removal during IAC exposure for tumor resection. Surgical techniques based on these anatomic findings facilitate tumor resection while preserving the labyrinth.

UI MeSH Term Description Entries
D007758 Ear, Inner The essential part of the hearing organ consists of two labyrinthine compartments: the bony labyrinthine and the membranous labyrinth. The bony labyrinth is a complex of three interconnecting cavities or spaces (COCHLEA; VESTIBULAR LABYRINTH; and SEMICIRCULAR CANALS) in the TEMPORAL BONE. Within the bony labyrinth lies the membranous labyrinth which is a complex of sacs and tubules (COCHLEAR DUCT; SACCULE AND UTRICLE; and SEMICIRCULAR DUCTS) forming a continuous space enclosed by EPITHELIUM and connective tissue. These spaces are filled with LABYRINTHINE FLUIDS of various compositions. Labyrinth,Bony Labyrinth,Ear, Internal,Inner Ear,Membranous Labyrinth,Bony Labyrinths,Ears, Inner,Ears, Internal,Inner Ears,Internal Ear,Internal Ears,Labyrinth, Bony,Labyrinth, Membranous,Labyrinths,Labyrinths, Bony,Labyrinths, Membranous,Membranous Labyrinths
D008297 Male Males
D009464 Neuroma, Acoustic A benign SCHWANNOMA of the eighth cranial nerve (VESTIBULOCOCHLEAR NERVE), mostly arising from the vestibular branch (VESTIBULAR NERVE) during the fifth or sixth decade of life. Clinical manifestations include HEARING LOSS; HEADACHE; VERTIGO; TINNITUS; and FACIAL PAIN. Bilateral acoustic neuromas are associated with NEUROFIBROMATOSIS 2. (From Adams et al., Principles of Neurology, 6th ed, p673) Acoustic Neuroma,Melanocytic Vestibular Schwannoma,Schwannoma, Acoustic,Schwannoma, Vestibular,Acoustic Neuroma, Cerebellopontine Angle,Acoustic Tumor,Angle Tumor,Cerebellopontine Angle Acoustic Neuroma,Cerebellopontine Angle Tumor,Neurilemmoma, Acoustic,Neurilemoma, Acoustic,Neurinoma of the Acoustic Nerve,Neurinoma, Acoustic,Neuroma, Acoustic, Unilateral,Vestibular Schwannoma,Acoustic Neurilemmoma,Acoustic Neurilemmomas,Acoustic Neurilemoma,Acoustic Neurilemomas,Acoustic Neurinoma,Acoustic Neurinomas,Acoustic Neuromas,Acoustic Schwannoma,Acoustic Schwannomas,Acoustic Tumors,Angle Tumor, Cerebellopontine,Angle Tumors,Angle Tumors, Cerebellopontine,Cerebellopontine Angle Tumors,Melanocytic Vestibular Schwannomas,Neurilemmomas, Acoustic,Neurilemomas, Acoustic,Neurinomas, Acoustic,Neuromas, Acoustic,Schwannoma, Melanocytic Vestibular,Schwannomas, Acoustic,Schwannomas, Melanocytic Vestibular,Schwannomas, Vestibular,Tumor, Acoustic,Tumor, Angle,Tumor, Cerebellopontine Angle,Tumors, Acoustic,Tumors, Angle,Tumors, Cerebellopontine Angle,Vestibular Schwannoma, Melanocytic,Vestibular Schwannomas,Vestibular Schwannomas, Melanocytic
D010579 Petrous Bone The dense rock-like part of temporal bone that contains the INNER EAR. Petrous bone is located at the base of the skull. Sometimes it is combined with the MASTOID PROCESS and called petromastoid part of temporal bone. Petrous Apex,Petrous Pyramid,Bone, Petrous,Petrous Bones
D002102 Cadaver A dead body, usually a human body. Corpse,Cadavers,Corpses
D004712 Endolymphatic Sac The blind pouch at the end of the endolymphatic duct. It is a storage reservoir for excess ENDOLYMPH, formed by the blood vessels in the membranous labyrinth. Endolymphatic Sacs,Sac, Endolymphatic,Sacs, Endolymphatic
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective

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