Modified parapetrosal presigmoid approach to facial nerve canal decompression of facial nerve palsy / 中华创伤杂志

Objective To discuss the surgical outcome and operative technique of the modified trans-petrosal presigmoid approach in treating cases with facial nerve palsy after petral bone fracture trea- ted with facial nerve canal decompression method.Methods A total of 15 cases with facial nerve pal- sy were treated with traumatic facial nerve canal decompression technique with the trans-petrosal presig- mold approach combined with high-dose hormone therapy,whereas 12 cases were treated with traditional Chinese medicine.The clinical data were analysed and compared retrospectively according to House- Brackmann facial nerve grading scale.Results At acute stage,eight(53.3%)out of 15 cases recov- ered to levelⅠ(P＜0.05),with no significant postoperative complications such as CSF leakage. Conclusions This approach is simple and safe and can expose extensively the facial nerve bone canal and effectively alleviate the edemous facial nerve aided by high-dose hormone therapy.Therefore,it is suitable for surgical treatment of acute facial nerve palsy after petral bone fractures.

Posterior Circulation Aneurysm Surgery / 대한뇌혈관외과학회지

Surgical treatment of posterior circulation aneurysms are still challenging to the neurosurgeons, requiring highly skilled hands. Patients with intracranial aneurysms operated on from January 1984 to January 2003 have been reviewed retrospectively. During that period 104 patients with 110 posterior circulation aneurysms underwent operation in our institute. Among them 47 patients had 49 aneurysms at the basilar bifurcation. The posterior cerebral artery aneurysms (PCEAA) 11, the superior cerebellar artery aneurysms (SCAA) 18, the anterior inferior cerebellar aneurysms (AICAA) 6, the vertebral artery aneurysms (VAA) 8 and the posterior inferior cerebellar artery aneurysms (PICAA) 18. The surgical approaches for BBAA, SCAA and PCEAA (proximal to P4) were pterional route in 70 aneurysms and subtemporal in 4. Modified pterional approach was suitable for most of such aneurysms. For lower basilar trunk aneurysms (AICAA and VBJA), both far lateral suboccipital craniectomy and petrosal presigmoid approach had been tried and the presigmoid one seemed to be the choice of approach. The author achieved aneurysmal neck clipping in the 82 (73%) aneurysms, wrapping in other 15 and proximal clipping in the other 13. The operative mortality and morbidity were 6% and 17% each, which were comparable to the other series. Concerning surgical complications, transient oculomotor palsies were most frequent (38%), followed by transient hemiparesis, thalamic infarction, status epilepticus and peripheral infarction of the parent-arterial territory.

Presigmoid Transpetrosal Approach for Recurrent Acoustic Neurinomas: Indications and Surgical Results

OBJECTIVE: In order to facilitate total removal with preservation of the facial nerve, the authors applied presigmoid(PS) approach in some patients with recurrent acoustic neurinoma(AN) patients who had undergone previous retrosigmoid(RS) approaches. The surgical outcomes of PS approach were retrospectively analyzed and compared to those of RS approaches and we suggest the indication of PS approach for recurrent AN. METHODS: From 1989 to 1999, twenty-one of 183 operated AN patients underwent re-operation due to regrowth of the residual tumors. Nine of the 21 recurrent tumors were removed by PS approach and 12 cases underwent RS approach. The surgical extent of removal and the facial nerve preservation rate were compared between the two different approaches. RESULTS: In PS approaches, the total removal was achieved in four patients(44%) and the facial nerve could be identified and preserved anatomically in all patients. Among 12 cases who underwent RS approaches, the rate of total removal was 44% and the facial nerve identified and preserved in only 5 cases (42%). The rate of facial nerve preservation was significantly different between two modes of approaches (p=0.0007). CONCLUSION: PS transpetrosal approach is recommended in recurrent AN patients who had underwent RS approach previously and already lost the hearing. Early identification of the facial nerve and easy removal of the tumors can be achieved using the PS approach.

Application of Double Flap Reconstruction to Craniectomy through Transpetrosal-presigmoid Approach for Petroclival Tumor:Report of 14 Cases / 中国微创外科杂志

Objective To evaluate the efficacy of double flap reconstruction after craniectomy through transpetrosal-presigmoid approach in the treatment of petroclival tumor.Methods A total of patients with petroclival tumor were enrolled in this study.Craniectomy was performed on them through the transpetrosal-presigmoid approach,and then double flap reconstruction was carried out.After the temporo-occipotal free osseous flap(retrosigmoid flap)was obtained,the superficial flap of the mastoid process(presigmoid flap)was freed by grinding and drilling.During the operation,partial petrosectomy and mastoidectomy were avoided to protect the semicircular canals and cochlea.Results Among the 14 cases,radical resection of the tumor was performed on 8 patients,subtotal resection on 3,and partial resection on 3.Two patients developed CSF leak through the ear.No subcutaneous hydrops or intracranial infection was found in the patients.The patients were followed up at 3 and 6 months after the operation,during which no complications were detected.Conclusions The rates of CSF leak,subcutaneous hydrops,and intracranial infection are low after applying double flap reconstruction to craniectomy through the transpetrosal-presigmoid approach.The procedure are mini-invasive and safety.

Microsurgical anatomy of the presigmoid translabyrinthine keyhole approach / 中华显微外科杂志

Objective To design a new presigmoid translabyrinthine keyhole approach assisted by Stryker neuro-navigation system according to the keyhole idea,and observe microscopic anatomy structures, which could be.regarded as the bases of this approach in clinical application.Methods Navigation data were established on 8 cadaveric heads fixed by formalin and perfused intracranial vessels with colored silicone. A 7-cm postauricular C-shaped skin incision as we reported was performed.After elevating the skin flap and musculofascial flap,a 3.5 cm?3.0 cm bone window was made.On skeletonizing the sigmoid sinus,bony lab- yrinth and the canal for facial nerve,the presigmoid retrolabyrinthine,partial labyrinthectomy with petrous api- cectomy,translabyrinthine keyhole approaches were simulated in turn.The length of important structures ex- posed and the angle of vision were measured step by step, and the anatomic structures were observed.Re- suits The approach-correlated bone could precisely be drilled with the aid of neuro-navigation,which could avoid the bewilder in drilling process.The angles of visual field,the length of clivus andⅦcranial nerve were significantly increased after partial labyrinthectomy with petrous apicectomy or all labyrinth removal,but there were no significant difference between partial and all labyrinth removal.The retrolabyrinthine keyhole approach spares hearing and facial function but provided for limited window of petroclival region exposure.The partial labyrinthectomy with petrous apicectomy keyhole approach provided wider exposure to petroclival region,cere- bellopontine angle,prepontine region and posterior cavernous sinus;an area between theⅢ-XI cranial nerves was easily visible with an excellent chance of hearing and facial nerve preservation.The translabyrin- thine keyhole approach,producing more morbidity,provided for greater versatility in treating lesions,added little exposure of petroclival region.Conclusion The presigmoid translabyrinthine keyhole approach,which could provide excellent exposure of the petroclival region,was feasible to be performed in our study.The ap- proach-correlated bone could be precisely removed assisted by neuro-navigation system.The exposure was oh- viously increased hy partial labyrinthectomy with petrous apicectomy or all labyrinthine removal,the former provided an excellent chancre of hearing and facial nerve preservation.

Surgical Experience of Posterior Circulation Aneurysms: Clinical Analysis of 64 Cases

Surgical treatment of posterior circulation aneurysms are still challenging to the neurosurgeons, requiring highly skilled hands. During the past 10 years, the senior author(DH Han) operated upon 64 posterior circulation aneurysms. The number of the basilar bifurcation aneurysms(BBAA) were 31(48%), the posterior cerebral artery aneurysms(PCEAA) 7, the superior cerebellar artery aneurysms(SCAA) 10, the anterior inferior cerebellar aneurysms(AICAA) 3, the vertebro-basilar junction aneurysms(VBJA) 2, the vertebral artery aneurysms(VAA) 5 and the posterior inferior cerebellar artery aneurysms(PICAA) 6. The surgical approaches for BBAA, SCAA and PCEAA(proxinal to P4) were pterional route in 41 aneurysms and subtemporal in 4. Modified pterional approach was suitable for most of such aneurysms. For lower basilar trunk aneurysms(AICAA and VBJA), both far lateral suboccipital craniectomy and petrosal presigmoid approach had been tried and the presigmoid one seemed to be the choice of approach. The authors achieved aneurysmal neck clipping in the 48(75%) aneurysms, wrapping in other 8 and proximal clipping in the other 8. The operative mortality and morbidity were 6% and 17% each, which were comparable to the other series. Concerning surgical complications, transient oculomotor palsies were most frequent(38%), followed by transient hemiparesis, thalamic infarction, status epilepticus and peripheral infarction of the parent-arterial territory.