Objective: By summarizing the technical points and therapeutic outcomes of combing infratemporal fossa approach (IFA) and internal carotid artery (ICA) reconstruction for the colossal skull base tumor invading ICA in petrous bone, the clinical application value was discussed. Methods: Five patients (2 males, 3 females,aging from 27 to 55 years old) who received surgeries between July 2015 and May 2017 for lateral skull base pathology involved petrous ICA using technique combined IFA and pre-reconstruction, were reviewed. Results: Among the five patients, three were paraganglioma of head and neck, one was carotid aneurysms, and one was recurrent adenoid cystic carcinoma (ACC). The median tumor size in the largest cross-section was 60 mm × 51 mm (range, 28 mm × 22 mm-72 mm × 58 mm). Complete excision was achieved with IFA and ICA reconstruction. The median blood loss volume was 1 000 ml (range, 600-2 500 ml). Four cases showed no new long-term neurologic sequelae, while one showed hemiplegia due to graft vessel occlusion. Except for the one with ACC having facial nerve cut, others achieved good facial nerve function of HB grade Ⅰ to Ⅱ during 3 to 12 months, follow-up. No tumor recurrence was observed over the median duration of follow-up for above 36 months (range, 36-58 months). Conclusion: For lesions involved superior part of ICA, which is unable to separate from ICA, IFA and ICA reconstruction can achieve complete excision.
Adult ; Carotid Artery, Internal/surgery* ; Female ; Humans ; Infratemporal Fossa ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Petrous Bone/surgery* ; Skull Base/surgery* ; Skull Base Neoplasms/surgery*

OBJECTIVE: To explore the clinical characteristics, diagnosis method and treatment of petrous apex cholesteatoma. METHOD: A retrospective analysis was taken with respects to the clinical characteristics, diagnosis and surgical management of 38 patients who underwent surgery for petrous apex cholesteatoma in our department. RESULT: (1)31 patients had unilateral hearing loss and facial paralysis of different degree, 27 patients were firstly characterized with hearing loss, and followed by facial paralysis. 6 cases had facial paralysis as the main performance. (2)17 patients had syndrome of tinnitus, and 15 patients had syndrome of vertigo and 4 cases of severe pain of ear. (3)All patients had petrous bone destroy with high resolution CT scan, while MRI suggests the presence of pathological changes in petrous apex. (4)All patients were taken surgeries to remove the lesion, and translabyrinth approach was chosen for 23 patients, middle cranial fossa approach is 12, while 3 case has choose endoscopic approach. 8 cases were operated with facial nerve decompression. 7 cases was taken end to end anastomosis. 3 cases of great auricular nerve transplantation. There is no recurrence in follow-up of 1 years to 2 years. CONCLUSION The clinical manifestations of petrous apex cholesteatoma lack specificity, and high resolution CT and MRI has important value in the diagnosis of petrous apex cholesteatoma. The strategy of surgical operation should be taken according to the classification, location of petrous apex cholesteatoma as well as hearing level and facial nerve function with patients.
Cholesteatoma ; pathology ; surgery ; Cranial Fossa, Middle ; Decompression, Surgical ; Facial Nerve ; Facial Paralysis ; Hearing Loss ; Hearing Loss, Unilateral ; Humans ; Magnetic Resonance Imaging ; Petrous Bone ; Recurrence ; Retrospective Studies ; Tomography, X-Ray Computed

OBJECTIVE: To explore the clinical characteristics, diagnosis and surgical management of petrous bone cholesteatoma. METHOD: The data of 12 patients who underwent surgery for petrous bone cholesteatoma(PBC) were retrospectively analyzed with respects to the clinical characteristics, diagnosis and management. RESULT: Seven cases were characterized by a long otitis media history, severe hearing loss, and facial paralysis. In contrast, 5 cases were characterized with the symptoms of facial paralysis, hearing loss and vertigo attack and the absence of early otorrhea history. Trans labyrinth approach was chosen for 2 cases,while trans labyrinth-cochlear approach for 10. Cochlea was involved in 10 cases, while internal auditory canal in 9 and semicircular canal in 11. Otoscope was used in 1 case. Four patients were treated by partial resection of petrous apex and ear canal closure with good results. After years of follow-up, three recurrence cases were operated for a second time. Simultaneous facial nerve anastomosis or decompression was performed. The function of facial nerve recovered from V-VI to Ill-IV (House and Brackmann grading) in 6 anastomosis cases and from IV-V to II- IlI in 3 cases of decompression. CONCLUSION Petrous bone cholesteatoma was characterized by severe hearing loss, and facial paralysis. Surgical approaches are decided according to the extent of lesion and hearing status. Our study indicated that otoscope would help to ensure a radical removal of the pathology in cases with deep involvement and restricted vision. Partial resection of petrous bone and ear canal closure could be effective solution for challenging cerebrospinal fluid otorrhea with large dural defects and protecting vital neurovascular structures.
Adolescent ; Adult ; Child ; Child, Preschool ; Cholesteatoma ; diagnosis ; pathology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Petrous Bone ; pathology ; surgery ; Retrospective Studies ; Young Adult

Humans ; Nose ; anatomy & histology ; surgery ; Petrous Bone ; anatomy & histology ; surgery

Cholesteatoma ; diagnosis ; surgery ; Humans ; Petrous Bone ; pathology

OBJECTIVE: To investigate the clinical features, operative approach and method of petrous apex cholesteatoma, to improve the effect of operation and to reduce surgical complications. METHOD: Two cases of patients with giant petrous apex cholesteatoma were treated by trans labyrinth approach, one of which was successfully operated with oto-endoscope-assisted surgery. RESULT: No cerebrospinal fluid leakage, infection, vertigo or disequilibrium was found in the two cases after operation. CONCLUSION Temporal CT and MRI are of great importance in clinical diagnosis and choice of surgical approach. Surgery by trans-labyrinth approach paves way for removing cholesteatoma thoroughly, dealing with facial nerve and repairing cerebrospinal fluid leakage. Surgery is considered to be the only way to cure petrous apex cholesteatoma, while the key procedure to prevent recurrence lies in complete removal of lesion, long-time strict follow up and regular clearance of the surgical field.
Cholesteatoma ; diagnosis ; diagnostic imaging ; surgery ; Endoscopy ; Female ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Petrous Bone ; pathology ; Tomography, X-Ray Computed

BACKGROUNDDespite the presigmoid transpetrosal approach has been used by different researchers in various ways, the surgical injury rate remains high. Applying a minimally invasive keyhole idea, we devised a presigmoid transpetrosal keyhole approach (PTKA), classified and quantitatively assessed their approach to the petroclival area on a cadaver model by using a neuronavigation system.

METHODSThe presigmoid transpetrosal keyhole approach was divided into four increasingly morbidity-producing steps: retrolabyrinthine, partial labyrinthectomy with petrous apicectomy, translabyrinthine and transcochlear keyhole approaches. Six latex-injected cadaveric heads (twelve sides) underwent dissection in which a neuronavigation system was used. An area of exposure 10 cm superficial to a central target (working area) was calculated. The area of clival exposure with each subsequent dissection was also calculated.

RESULTSThe retrolabyrinthine keyhole approach (RLK) spares hearing and facial function in theory but provides for only a small window of upper clival exposure. The view afforded by partial labyrinthectomy with petrous apicectomy keyhole approach (PLPAK) provides for up to four times this exposure. The translabyrinthine keyhole approach (TLK) and transcochlear keyhole approach (TCK), although producing more morbidity, add little in terms of a larger petroclival window. However, with each step, the surgical freedom for manipulation of instruments increases.

CONCLUSIONSThe presigmoid transpetrosal keyhole approach to the petroclival area is feasible and useful. The RLK has relatively limited utility. For lesions without bone invasion, the PLPAK provides a much more versatile exposure with an excellent chance of hearing and facial nerve preservation. The TLK provides for greater versatility in treating lesions but clival exposure is not greatly enhanced. The TCK adds little in terms of intradural exposure but should be reserved for cases in which access to the petrous carotid artery is necessary.

Cadaver ; Cranial Fossa, Posterior ; surgery ; Humans ; Minimally Invasive Surgical Procedures ; methods ; Neuronavigation ; Petrous Bone ; surgery

OBJECTIVETo evaluate a facial rhytidectomy technique to reduce the complications of temporal alopecia and incisional scar hyperplasia.

METHODSThe 82 aged patients were divided into 2 groups in random way: group A in 46 with the use of the three-point relief-tension suspension technique and group B in 36 as control. In group A, the two point of every relief-tension suture was located respectively in the subcutis of the hairline and fascia under the incision. The parallel three sutures formed a mechanical plane to make the relief suture more strong and permanent. The temporal alopecia and incisional scar was observed with the follow-ups after the operation.

RESULTSWith the 82 cases of facial rhytidoplasty, the complications of the temporal alopecia and incisional scars in group A were much less than in group B.

CONCLUSIONSThis technique could decrease the complications such as temporal alopecia and incisional scars, and get a good and long term effect of temporal lifting simultaneously.

Adult ; Fasciotomy ; Female ; Humans ; Male ; Middle Aged ; Petrous Bone ; surgery ; Rhytidoplasty ; methods

OBJECTIVETo discuss the reasonable choice of the surgical approach to petroclvial tumors.

METHODSThe clinical data of consecutive 53 patients with the petroclival tumors, treated from June 2002 to June 2004, were reviewed to compare the different surgical approaches to pertroclival region.

RESULTSubtemporal transtentorial approach were used in 11 patients, suboccipital retrosigmoid approach in 12 patients, (transzygomatic or orbitozygomatic) frontotemporal (pterional) approach in 12 patients, presigmoid sinus approach in 2 patients, subtemporal and retrosigmoid sinus combined approach in 7 patients, subtemporal anterior petrosal extradural approach in 7 patients and extended transfrontal base extradural approach in 2 patients. Of all patients in this group, total tumor removal was achieved in 32 patients, subtotal in 9, largely partial in 12. The new cranial nerve deficit took place in 16 patients postoperatively, two patients died from coma and serious pneumonia.

CONCLUSIONSUsing perfect microsurgical technique, conventional surgical approaches on petroclival region such as suboccipital retrosigmoid approach, subtemporal transtentorial approach can be suitable for most petroclival tumor with the help of neuro-navigation and neuro-endoscopy. To the epidural tumor on petroclival region, the epidural approach should be used with less invasion to the brain tissue. And to the giant petroclival tumor, the combined-tentorial approach can provide an excellent access and exposure to the tumor.

Adolescent ; Adult ; Aged ; Child ; Dura Mater ; surgery ; Female ; Humans ; Male ; Meningeal Neoplasms ; surgery ; Microsurgery ; methods ; Middle Aged ; Neuroendoscopes ; Neuronavigation ; Neurosurgical Procedures ; methods ; Petrous Bone ; surgery ; Retrospective Studies ; Skull Base ; surgery

OBJECTIVETo explore the reliability of humping the forehead and temple by en block frontal temporal silicone .

METHODSMake wax mold by piling up wax slices layer by layer according to the rang of depressing of the forehead and temple, the section being humped and the hight need to be projected. Order the silicone block according to the dimension of the wax mold. Make the implant from the silicon block. Under local anaesthesia dissection under the superficial temporal fascia and galea through forehead and two temporal incisions. Implant the silicon through the middle incision.

RESULTSTotal 18 cases in this group were followed up for 3-12 months. Wound healed primarily without infection. I case with early blood effusion cured after aspiration. l case with later clear effusion cured after aspiration ad injection of prednisone in to the capsular. The frontal temporal contours were satisfactory . No outline of the implant was seen.

CONCLUSIONIt is safety and satisfied to hump the forehead and temple by en block frontal temporal silicone.

Adult ; Female ; Forehead ; surgery ; Head ; surgery ; Humans ; Middle Aged ; Petrous Bone ; surgery ; Prosthesis Implantation ; Rhytidoplasty ; methods ; Silicones