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Journal of Neurological Surgery Part B: Skull Base, 2013
The Laryngoscope, 2013
BACKGROUND Facial nerve injury is a potential complication of otologic surgery as its dissection ... more BACKGROUND Facial nerve injury is a potential complication of otologic surgery as its dissection within the region of the tympanic and mastoid segments is an integral component of middle ear and mastoid surgery. The tympanic segment of the facial nerve is vulnerable as it can be normally dehiscent, and the incidence of dehiscence increases in the presence of chronic otitis media and cholesteatoma. Additionally, during mastoidectomy and posterior tympanotomy, the descending portion of the facial nerve is at risk for iatrogenic injury. Although there is no substitute for knowledge of normal facial nerve anatomy, potential aberrations in the course of the facial nerve, anatomic identification of the facial nerve, and surgical experience, the use of facial nerve integrity monitoring (NIM) during middle ear and mastoid surgery has been advocated as a means to reduce the surgical risk of facial nerve injury. In contrast to neurotologic procedures where it has been widely accepted as standard of care, routine use of facial NIM in otologic surgery remains controversial. In this Triological Society Best Practice review, we examined the evidence regarding the use of facial NIM in otologic surgery.
Radiology Research and Practice, 2013
Imaging plays a critical role in the evaluation of a number of facial nerve disorders. The facial... more Imaging plays a critical role in the evaluation of a number of facial nerve disorders. The facial nerve has a complex anatomical course; thus, a thorough understanding of the course of the facial nerve is essential to localize the sites of pathology. Facial nerve dysfunction can occur from a variety of causes, which can often be identified on imaging. Computed tomography and magnetic resonance imaging are helpful for identifying bony facial canal and soft tissue abnormalities, respectively. Ultrasound of the facial nerve has been used to predict functional outcomes in patients with Bell’s palsy. More recently, diffusion tensor tractography has appeared as a new modality which allows three-dimensional display of facial nerve fibers.
The Laryngoscope, 2012
INTRODUCTION The cerebellopontine angle (CPA) is a complex triangular space bounded by the brains... more INTRODUCTION The cerebellopontine angle (CPA) is a complex triangular space bounded by the brainstem medially, the cerebellum superiorly and posteriorly, and the temporal bone laterally. Tumors of the CPA account for 5% to 10% of all intracranial neoplasms, with the most frequent being vestibular schwannomas, followed by meningiomas and epidermoid tumors. Multiple surgical approaches are available for extirpation of these lesions. For tumors primarily located in the CPA with minimal lateral extension into the internal auditory canal (IAC), the retrosigmoid approach provides wide exposure and improved safety when dissecting the tumor from the brainstem and lower cranial nerves.1 The main pitfall of the standard retrosigmoid/suboccipital approach is the need for a larger, posterior craniotomy and cerebellar retraction to fully visualize the CPA. In the standard approach, a craniotomy is first performed immediately posterior to the sigmoid sinus and inferior to the transverse sinus. Cerebrospinal fluid (CSF) pressure is then decreased through decompression of the cistern. Retractors are then placed to retract the lateral cerebellum posteriorly.2 We present surgical modifications to the standard retrosigmoid approach that eliminate the need for cerebellar retraction for visualization of the CPA and utilized only native bone for reconstruction of the operative defect. Also, complication rates in association with this approach as compared to previously reported rates with the standard retrosigmoid/suboccipital approach will be presented.
Otology & Neurotology, 2012
Journal of Neurological Surgery Part B: Skull Base, 2013
The Laryngoscope, 2013
BACKGROUND Facial nerve injury is a potential complication of otologic surgery as its dissection ... more BACKGROUND Facial nerve injury is a potential complication of otologic surgery as its dissection within the region of the tympanic and mastoid segments is an integral component of middle ear and mastoid surgery. The tympanic segment of the facial nerve is vulnerable as it can be normally dehiscent, and the incidence of dehiscence increases in the presence of chronic otitis media and cholesteatoma. Additionally, during mastoidectomy and posterior tympanotomy, the descending portion of the facial nerve is at risk for iatrogenic injury. Although there is no substitute for knowledge of normal facial nerve anatomy, potential aberrations in the course of the facial nerve, anatomic identification of the facial nerve, and surgical experience, the use of facial nerve integrity monitoring (NIM) during middle ear and mastoid surgery has been advocated as a means to reduce the surgical risk of facial nerve injury. In contrast to neurotologic procedures where it has been widely accepted as standard of care, routine use of facial NIM in otologic surgery remains controversial. In this Triological Society Best Practice review, we examined the evidence regarding the use of facial NIM in otologic surgery.
Radiology Research and Practice, 2013
Imaging plays a critical role in the evaluation of a number of facial nerve disorders. The facial... more Imaging plays a critical role in the evaluation of a number of facial nerve disorders. The facial nerve has a complex anatomical course; thus, a thorough understanding of the course of the facial nerve is essential to localize the sites of pathology. Facial nerve dysfunction can occur from a variety of causes, which can often be identified on imaging. Computed tomography and magnetic resonance imaging are helpful for identifying bony facial canal and soft tissue abnormalities, respectively. Ultrasound of the facial nerve has been used to predict functional outcomes in patients with Bell’s palsy. More recently, diffusion tensor tractography has appeared as a new modality which allows three-dimensional display of facial nerve fibers.
The Laryngoscope, 2012
INTRODUCTION The cerebellopontine angle (CPA) is a complex triangular space bounded by the brains... more INTRODUCTION The cerebellopontine angle (CPA) is a complex triangular space bounded by the brainstem medially, the cerebellum superiorly and posteriorly, and the temporal bone laterally. Tumors of the CPA account for 5% to 10% of all intracranial neoplasms, with the most frequent being vestibular schwannomas, followed by meningiomas and epidermoid tumors. Multiple surgical approaches are available for extirpation of these lesions. For tumors primarily located in the CPA with minimal lateral extension into the internal auditory canal (IAC), the retrosigmoid approach provides wide exposure and improved safety when dissecting the tumor from the brainstem and lower cranial nerves.1 The main pitfall of the standard retrosigmoid/suboccipital approach is the need for a larger, posterior craniotomy and cerebellar retraction to fully visualize the CPA. In the standard approach, a craniotomy is first performed immediately posterior to the sigmoid sinus and inferior to the transverse sinus. Cerebrospinal fluid (CSF) pressure is then decreased through decompression of the cistern. Retractors are then placed to retract the lateral cerebellum posteriorly.2 We present surgical modifications to the standard retrosigmoid approach that eliminate the need for cerebellar retraction for visualization of the CPA and utilized only native bone for reconstruction of the operative defect. Also, complication rates in association with this approach as compared to previously reported rates with the standard retrosigmoid/suboccipital approach will be presented.
Otology & Neurotology, 2012