Object: The aim of this study was to report the results in a consecutive series of patients who had undergone an endoscopic endonasal approach (EEA) for drainage of a petrous apex cholesterol granuloma (CG).
Methods: Seventeen cases with a confirmed diagnosis of petrous apex CG were identified from a database of more than 1600 patients who had undergone an EEA to skull base lesions at the authors' institution in the period from 1998 to 2011. Clinical outcomes were reviewed and compared with those in previous studies of open approaches.
Results: Nine patients underwent a transclival approach and 8 patients underwent a combined transclival and infrapetrous approach. A Silastic stent was used in 11 patients (65%), a miniflap in 4 (24%), and a simple marsupialization of the cyst in 3 (18%). All symptomatic patients had partial or complete improvement of their symptoms postoperatively and at the follow-up (mean follow-up 20 months, range 3-67 months). Complications developed in 3 patients (18%) including epistaxis, chronic serous otitis media, eye dryness, and a transient sixth cranial nerve palsy. Two patients (12%) had a symptomatic recurrence of the cyst requiring repeat endoscopic endonasal drainage. There were no instances of internal carotid artery injuries, CSF leaks, or new hearing loss. The mean postoperative hospital stay was 2 days (range 0.7-4.6 days). These results were comparable with those in previous studies of open approaches to petrous apex CGs. There was a strong correlation between the size of the cyst and the type of approach chosen (Rpb [point biserial correlation coefficient] = +0.67, p = 0.003359) and a very strong correlation between the degree of medial extension (defined by the V-angle) and the choice of approach (Rpb = +0.81, p < 0.0001). Based on these observations, the authors developed an algorithm for guiding the choice of the most appropriate route of drainage.
Conclusions: The EEA is a safe and effective alternative to traditional open approaches to petrous apex CGs.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.3171/2011.11.JNS111077 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Optimal Patient Positioning for Microvascular Decompression of Trigeminal Neuralgia Utilizing the "Arrowhead" Technique: A Technical Report.
Cureus
December 2024
Neurosurgery, Desert Regional Medical Center, Palm Springs, USA.
Microvascular decompression (MVD) is a neurosurgical operation used to treat trigeminal neuralgia (TN). The surgery is performed through a retrosigmoid approach, where a Teflon pledget is placed in between the offending vessel (most commonly the superior cerebellar artery) and trigeminal nerve. The surgery is performed within the superior aspect of the cerebellopontine angle (CPA) through a small working corridor that is triangulated by the petrous bone and tentorium.
View Article and Find Full Text PDFCharacterization of jugular bulb position on computed tomography (CT) with implications for excision of vestibular schwannomas.
Neurosurg Rev
January 2025
Department of Neurological Sciences, Christian Medical College Vellore- Ranipet Campus Vellore, Vellore, Tamil Nadu, 632517, India.
To describe the distribution of jugular bulb position and pneumatization of posterior lip of internal auditory meatus (IAM) in patients with vestibular schwannoma (VS). This retrospective study included 43 patients who had a thin slice (< 2 mm) CT temporal bone for preoperative planning of retrosigmoid approach for excision of VS between March 2011 and March 2021. On computed tomography (CT), high riding jugular bulb was defined by its relationship to IAM and correlated with type of jugular bulb according to Manjila et al.
View Article and Find Full Text PDFExternal Auditory Canal Transillumination-Guided Middle Fossa Approaches: An Anatomical Feasibility Study.
Oper Neurosurg (Hagerstown)
January 2025
Department of Neurosurgery, Yeditepe University School of Medicine, İstanbul, Türkiye.
Background And Objectives: The middle fossa approaches are tremendously versatile for treating small vestibular schwannomas, selected petroclival meningiomas, midbasilar trunk aneurysms, and lesions of the petrous bone. Our aim was to localize the internal acoustic canal and safely drill the petrous apex with these approaches. This study demonstrates a new method to locate the internal acoustic canal during surgery in the middle fossa.
View Article and Find Full Text PDFThe posterior petroclinoid fold and petroclival ligament ossification patterns.
Surg Radiol Anat
January 2025
Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias str, Goudi, Athens, 11527, Greece.
Background: The skull base ligaments have been extensively studied in the literature due to their clinical and surgical significance. The posterior petroclinoid fold (PPCNF) and petroclival ligament (PCVL) are two adjacent structures that have barely been studied and are frequently confused. The present study uses an innovative classification system to investigate the PPCNF and PCVL ossification patterns.
View Article and Find Full Text PDFA Case of Hemifacial Spasm Caused by Penetration of the Anterior Inferior Cerebellar Artery between the Facial Nerve and the Nervus Intermedius.
NMC Case Rep J
December 2024
Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan.
Hemifacial spasm (HFS) is a disorder that causes involuntary movements of the ipsilateral facial muscles because of vascular compression of the facial nerve. Microvascular decompression (MVD), a surgical procedure to detach the culprit vessel from the nerve is believed to be the most effective treatment for HFS. Nevertheless, in the rare case in which the vessel penetrates the nerve, positioning the vessel sufficiently far from the nerve is challenging.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!