[Treatment of the mastoid cavity in closed tympanoplasty].
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Biomedical subjects
Publications and source records attributed to M Sanna.
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This paper presents the modification made for a transcochlear approach which would permit reaching the pertoclivis area and proeponten cistern. The disadvantage, inconvenience of the approach used on 5 patient is discussed here.
The extended middle cranial fossa (EMCF) approach calls for removal of the petrous bone from its subtemporal surface in order to well expose the internal auditory canal (IAC) and the posterior fossa dura (PDF) around its meatus, safeguarding, at the same time, all the important, closely related, anatomical structures (the Gasserian ganglion (GG) and its third trigeminal division, the internal carotid artery (ICA), the cochlea, the posterior labyrinth, the superior petrosal sinus (SPS), the inferior petrosal sinus (IPS) and the jugular bulb (JB). The middle meningeal artery, on the other hand, could be divided when necessary. We dissected 25 temporal bones preserved in formaldehyde and those of five cadavers in order to define the limits of this approach. Measurements were taken so as to establish the limits of the approach as well as to determine the most appropriate angles and distances in working in this area. As previously suggested by the Senior Author (MS), we found it safer to start working medially in order to identify the IAC and then to extend the dissection laterally. The most constant angle proved to be that between the IAC and the SPS. The distances and areas found appear to be highly variable and difficult to rely upon. A thorough knowledge of this anatomy is of most importance for the surgeon who intends to use this approach.
Cholesteatoma involving the petrous compartment of the temporal bone is rare and is a difficult surgical challenge for the neuro-otological surgeon. A series of 60 cases of petrous bone cholesteatoma is presented. The diagnosis, surgical treatment, results, and complications are discussed. Our present surgical attitude is based on closed obliterative procedures that allow a wide field exposure with radical removal excision, control and protection of vital structures, and management of problems related to the facial nerve. The treatment of dura mater involved by matrix is still unsolved. Regular follow-up with CT and MRI is mandatory.