From their introduction, exclusively endoscopic approaches to the petrous bone represented new opportunities for treatment of many diseases involving that region,1 with better tissue preservation than achieved with standard microscopic techniques, possibly lower morbidity, and better preservation of vital structures such as facial nerve or otic capsule. Just as in middle ear endoscopic approaches, the pathology is located and attacked directly, limiting the damage or destruction of healthy tissue. Nevertheless, key problems in every kind of approach to petrous bone pathology are represented by preservation of facial nerve function and of hearing. Other anatomical structures that need to be maximally preserved are few in number but are very important: ● Dura mater of the posterior cranial fossa ● Dura mater of the middle cranial fossa ● Labyrinthine tract of the facial nerve ● Tympanic tract of the facial nerve ● Vertical tract of the internal carotid artery ● Horizontal portion of the internal carotid artery ● Jugular bulb ● Cochlea ● Posterior labyrinth. The fundamental prerequisite for this type of surgery is precise knowledge of the anatomy, and in particular the surgical anatomy, under endoscopic vision. The purpose of this chapter is to illustrate the preliminary experiences with exclusively transcanal endoscopic approaches to petrous bone pathology (in particular to the petrous apex and the fundus of the internal auditory canal). The following chapter will focus on combined approaches (endoscopic/microscopic). A further distinction can be made between approaches that allow sparing of the cochlear function and approaches that necessitate destruction of the inner ear with loss of auditory function. Note that none of these approaches requires the rerouting of the facial nerve. We consider two different exclusively transcanal approaches: ● Exclusively transcanal endoscopic infracochlear approach ● Exclusively transcanal, transvestibular/transcochlear approach.
Exclusively Endoscopic Transcanal Approach to the Inner Ear and Petrous Apex
Marchioni D;Molteni G
2014-01-01
Abstract
From their introduction, exclusively endoscopic approaches to the petrous bone represented new opportunities for treatment of many diseases involving that region,1 with better tissue preservation than achieved with standard microscopic techniques, possibly lower morbidity, and better preservation of vital structures such as facial nerve or otic capsule. Just as in middle ear endoscopic approaches, the pathology is located and attacked directly, limiting the damage or destruction of healthy tissue. Nevertheless, key problems in every kind of approach to petrous bone pathology are represented by preservation of facial nerve function and of hearing. Other anatomical structures that need to be maximally preserved are few in number but are very important: ● Dura mater of the posterior cranial fossa ● Dura mater of the middle cranial fossa ● Labyrinthine tract of the facial nerve ● Tympanic tract of the facial nerve ● Vertical tract of the internal carotid artery ● Horizontal portion of the internal carotid artery ● Jugular bulb ● Cochlea ● Posterior labyrinth. The fundamental prerequisite for this type of surgery is precise knowledge of the anatomy, and in particular the surgical anatomy, under endoscopic vision. The purpose of this chapter is to illustrate the preliminary experiences with exclusively transcanal endoscopic approaches to petrous bone pathology (in particular to the petrous apex and the fundus of the internal auditory canal). The following chapter will focus on combined approaches (endoscopic/microscopic). A further distinction can be made between approaches that allow sparing of the cochlear function and approaches that necessitate destruction of the inner ear with loss of auditory function. Note that none of these approaches requires the rerouting of the facial nerve. We consider two different exclusively transcanal approaches: ● Exclusively transcanal endoscopic infracochlear approach ● Exclusively transcanal, transvestibular/transcochlear approach.
I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
