Search

Purpose: The most used neurosurgical approach to reach cerebellar-pontine angle is the retrosigmoid route. This article describes the presigmoid approach which requires excellent knowledge of the labyrinthine block together with quantitative analysis of temporal bone CT., Methods: CT-based quantitative measurements were obtained in patients undergoing vestibular neurectomy with a presigmoid approach. Eighteen patients were enrolled, and five measures were taken: Trautmann's area, the petro-clival angle, presigmoid dura length and its angle. The relationship between these measurements and hospitalization days, operating times, and complications was explored., Results: The posterior semicircilar canal (PSC)-sigmoid sinus (SS) distance, presigmoid dura- internal auditory canal (IAC)-PSC angle, and duration of surgery are predictors of complications. Specifically, a PSC-sigmoid sinus distance <11 mm, a dura presig-IAC-PSC angle <14 are associated with the highest risk of complications., Conclusion: Preoperative temporal bone CT scan can guide the surgeon through the narrowest areas of the surgical approach. Trautmann's triangle area and petro-clival angle reduction are challenging and can be faced with combined microscopic-endoscopic technique, and with optics angulation-rotation. The retrolabyrinthine approach can enable hearing preservation and minimal cerebellar retraction., (Copyright © 2024. Published by Elsevier España, S.L.U.)

The embryology of the ear and the different congenital anomalies depending on the arrest in development at a particular embryologic date are reviewed. The historical and the actual attitude towards surgical correction is discussed. The classification system, the evaluation and patients selection, the timing of auricular reconstruction and atresiaplasty, the preoperative evaluation, the patient and parents counselling, the surgical technique, the complications and alternative techniques are discussed.

The histopathological changes in the temporal bones of three deceased donors individuals, two with concomitant acoustic tumors and one with concomitant petroclival meningioma have been studied. The differences between neuromas and meningiomas are examined. The different clinical relevance and the different therapeutic guidelines are discussed.

We have studied the temporal bones of 4 deceased donors, individuals one with cochlear saccular degeneration, another with Mondini dysplasia, another with an ossification of the basal turn of the cochlea and the round window, post meningitis and the fourth who was implanted 10 years before. The indications and contraindications for cochlear implant placement are discussed.

The histopathological changes in the temporal bones of one donor individual deceased for complications of neurofibromatosis type 2 are studied. The different modalities of presentation of neurofibromatosis and the criteria for the differential diagnosis are presented. The possibilities of the auditory brainstem implants in this pathology are discussed.

The histopathological changes in the temporal bones of 3 deceased donors individuals with concomitant chronic cholesteatomatous otitis media have been studied. The different forms of cholesteatoma are analyzed: the primary congenital, the primary acquired and the secondary acquired. The different clinical relevance and the different therapeutic guidelines are discussed.

We have chosen among many temporal bones of donors deceased individuals with concomitant otosclerosis, three particular cases, one with classic otosclerosis, another with cochlear otosclerosis with concomitant oval window ankylosis and another with cochlear otosclerosis without stapes fixation. The different histopathologic features are discussed and clinical and therapeutical guidelines are proposed.

The histopathological changes in the temporal bones of two deceased donors individuals with concomitant Ménierè's disease have been studied. In one temporal bone we have found a blockage of the endolymphatic duct by abnormal bone. The histopathological modifications and the different therapeutic options are discussed. Clinical guidelines are proposed.

Otitis media (OM) is an infection localized in the middle ear: mastoid, middle ear cavity, Eustachian tube. The classification of OM includes otitis media with effusion, otitis media without effusion, and chronic otitis media. A rare complication of chronic otitis is cholesterol granuloma of the petrous apex. It may develop in any aerated portion of the temporal bone but most commonly develops when a pathologic process obstruct the air cell tracts to the petrous apex preventing normal aeration.

A classification of otitis media is proposed and the histopathological changes of otitis media with effusion are reviewed post mortem on two temporal bones. A case of adhesive otitis media is observed on temporal bone slides. The clinical and therapeutic aspect are examined and treatment guidelines are proposed.