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Modified petrosal approach using cosmetic osteoplastic craniotomy with NEURO-SAT guidance.

The petrosal approach has become a routine procedure for petroclival lesions, but there are some disadvantages such as the time-consuming craniotomy during surgery and depressed deformity of the mastoid area after surgery. To solve these disadvantages, we modified the petrosal approach. Before surgery, the three-dimensional points of the sigmoid sinus and semicircular canals are calculated on computed tomography scan and are input to a computer. A single temporooccipital bone flap is made, and the outer table of bone overlying the mastoid is preserved by forming a narrow groove with a small air drill and cutting the outer table with a chisel. After removing these two free bone flaps, mastoidectomy is performed guided by NEURO-SAT (neuronavigation by computer-assisted frameless stereotaxy). The mastoid bone can be drilled out safely and quickly. The two bone flaps are connected and replaced at the end of the procedure. Osteoplastic petrosal craniotomy guided by NEURO-SAT can achieve a quick craniotomy and satisfactory cosmetic result.

Abducens Nerve↗

Surgical control of the mastoid segment in chronic ear disease in 1988.

The basic surgical guidelines for mastoid segment control are described in chronic ear disease. Dense cortical bone paté and mastoid tip bone chips are collected for possible obliteration of the surgical cavity produced. A meatally based musculoperiosteal flap is raised if "canal wall-down" surgery is anticipated. Mastoid bone surgery must be meticulous and the sigmoid, cerebellar and dural plates are first exposed. This is followed by a perilabyrinthine dissection. Tympanic or epitympanic surgery is connected with mastoidectomy as needed. All cavities are then obliterated.

Cholesteatoma↗

MR imaging of middle ear cholesteatomas.

We prospectively evaluated MR images of 14 patients who had chronic otitis media and who were suspected of having cholesteatomas on otologic examination and/or on high resolution CT. Cholesteatomas were verified in the middle ear and/or mastoid at surgery in nine patients. Cholesteatomas appeared isointense relative to gray matter on T1-weighted spin echo MR images (T1WI) and hyperintense on T2-weighted spin echo MR images (T2WI) in eight patients. Two cholesterol granulomas appeared hyperintense on both T1WI and T2WI. In three patients with chronic otitis media the associated mixed granulation tissue and fluid collection was revealed as nonspecific, heterogeneous signal intensity in two cases. In the third case the signal intensity was similar to that found in cholesteatomas.

Adult↗

Petrosquamosal suture and lamina.

The junction of the petrosal and squamosal portions of the temporal lobe has important relationships that are of interest to the otologist. The resultant suture extends from the glaserian fissure across the top of the middle ear cleft and into the mastoid portion of the temporal bone. It may permit quick passage of infection from the middle ear to the middle cranial fossa. The petrosa may override the squama, forcing it down into the tympanum, where it could cause malleus fixation and a conductive type hearing loss. In the mastoid the suture is identifiable on the surface, but in the interior it is represented by the petrosquamosal lamina. The deeper portion in the petrosal portion of the mastoid may be easily overlooked in surgery of the mastoid and may lead to facial nerve injury.

Adult↗

[Cochlear implantation through the middle fossa approach].

The inner part of cochlear implant is inserted into inner ear during surgery through mastoid and middle ear. It is a classical method, used in the majority cochlear centers in the world. This is not a suitable method in case of chronic otitis media and middle ear malformation. In these cases Colletti proposed the middle fossa approach and cochlear implant insertion omitting middle ear structures. In patient with bilateral chronic otitis media underwent a few ears operations without obtaining dry postoperative cavity. Cochlear implantation through the middle fossa approach was performed in this patient. The bone fenster was cut, temporal lobe was bent and petrosus pyramid upper surface was exposed. When the superficial petrosal greater nerve, facial nerve and arcuate eminence were localised, the cochlear was open in the basal turn and electrode were inserted. The patient achieves good results in the postoperative speech rehabilitation. It confirmed Colletti tesis that deeper electrode insertion in the cochlear implantation through the middle fossa approach enable use of low and middle frequencies, which are very important in speech understanding.

Adult↗