Hearing Preservation with the Transcrusal Approach to the Skull Base Lesion Combined with Other Transcranial Approach: Results of Consecutive Series of 5 Cases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study reviewed our experience and outcomes of surgery via transcrusal approach to the skull base lesions. SUBJECTS AND METHOD: We performed transcrusal approach technique on five patients with skull base lesions (Cavernous malformation, Petroclival meningioma, Craniopharyngioma, Anaplastic astrocytoma, and Trigerminal epidermoid cyst) aiming at preserving hearing. Pre-and post-operative pure tone audiometry (PTA) and caloric test were performed in all patients. The transcrusal approach technique was performed as reported in the previous references. The approach included trephination of the superior and posterior semicircular canals from the ampullae to the common crus. The main outcome of this study was preserving hearing and the vestibular function after surgery, which was determined by PTA and caloric test. RESULTS: The average diameter of skull base lesion of the five patients was 3.68 cm. The mean follow up period was 114.2 days. The pre-operative mean PTA of five patients was 11 dB. The mean PTA of five patients within seven days after surgery was 28 dB. The last measured mean PTA was 29.8 dB. The pre and post-operative caloric results measured revealed vestibular function deficit in all of the patients after surgery (mean decreased value: 64%). All patients were stable during the surgery. Complications included two cerebrospinal fluid leak (40%) and one cranial VI nerve deficit (20%). CONCLUSION: Transcrusal approach is a method that can simultaneously preserve hearing and afford enough exposure of the skull base lesion if appropriately combined with other transcranial approach. We performed transcrusal approach targeting skull base lesion with hearing preservation, and we found excellent hearing result with this technique.

Early Endoscopic Electrocoagulation of the Sphenopalatine Artery for Refractory Posterior Epistaxis: Preliminary Study

BACKGROUND AND OBJECTIVES: Intractable epistaxis is a challenging problem associated with clinical morbidity and high costs due to prolonged hospitalization. Early endoscopic electrocoagulation of the sphenopalatine artery can be a good alternative management. SUBJECTS AND METHODS: This study is a retrospective review of 6 patients with uncontrolled epistaxis between January 2013 and January 2014. A decision to surgically intervene was made within 24 hours of hospitalization in all cases. Endoscopic electrocoagulation of the sphenopalatine artery was conducted under general anesthesia. Clinical and hematologic information, preoperative and surgical care, postoperative complications and surgical outcome, and duration of preoperative and postoperative hospital stay were evaluated. RESULTS: Epistaxis was effectively controlled in all cases. Four patients (66.7%) complained of nasal dryness and one of them endured nasal crusting for 9 months after surgery. Recurrent posterior epistaxis occurred after 5 postoperative months in one case, which was successfully controlled without surgery. The average length of postoperative hospital stay was 2.5+/-0.5 days. The average total length of hospital stay was 4.8+/-0.8 days. CONCLUSIONS: Early endoscopic electrocoagulation of the sphenopalatine artery seems effective for controlling intractable epistaxis.