The Exclusive Endoscopic Traspromontorial Approach and Its Pilot Clinical Experiences

Objectives: Describe a minimally invasive transcanal endoscopic approach, starting from the external auditory canal and reaching the internal auditory canal, used to treat inner ear pathology. Methods: Three patients, affected respectively by cochlear schwannoma, acoustic neuroma, and temporal bone cholesteatoma, were treated by an exclusive endoscopic approach without external incisions. Surgical steps and useful landmarks were reviewed and described. Results: The operation provided a direct transcochlear intradural approach from lateral to medial and from external to internal auditory canal, without any external incision. The pathology was totally removed in all patients. Results regarding facial nerve were very satisfying. Hospital stay was markedly reduced compared to traditional approaches. Conclusions: The transcanal exclusive endoscopic approach proved successful for pathology removal involving the fundus, internal auditory canal, and cochlea. Potential future application of this kind of approach in lateral skull base surgery will depend on the development of technology and surgical and anatomical refinements.