Transcanal Endoscopic Infracochlear Approach for a Petrous Apex Cholesterol Granuloma

This video demonstrates a transcanal endoscopic infracochlear approach to the petrous apex in a patient with a large cholesterol granuloma. The patient presented with a history of profound left sensorineural hearing loss, hemifacial spasm, and House Brackmann Grade 2 facial function. Preoperative imaging demonstrated a T1 and T2 hyperintense heterogenous lesion in both petrous apices with the left being larger than the right on magentic resonance imaging. A computed tomography scan (CT) of the temporal bones demonstrates extension of the left petrous apex lesion into the internal auditory canal and cochlea.

Dr. Isaacson has had 2 patients who have had significant recovery of their bone line after using an infracochlear approach. In the unlikely event that the patient experiences hearing loss in the other ear, their cochlea is preserved for a possible CI. However, the patients hearing loss is likely secondary to the 8th nerve involvement of cholesterol granuloma erosion into IAC.

The patient in this surgical video has been monitored for a year. One year postop CT shows aeration of the apex. This patient’s facial spasm has resolved. Dr. Isaacson has used stents in the past, but in this case felt the opening was large enough that he could forego it. Patient did not recover their hearing.

DOI: http://dx.doi.org/10.17797/1wq11j68wa

Translabyrinthine Approach for Vestibular Schwannoma (Acoustic Neuroma) Resection

Contributors: Bruce E. Mickey and  J. Walter Kutz

This video highlights key steps to the translabyrinthine approach for vestibular schwannoma resection. It emphases identification of the facial nerve and the benefit of facial nerve monitoring in lateral skull base surgery.

DOI#: https://doi.org/10.17797/4w83z6uxam

Middle Fossa Approach for Vestibular Schwannoma (Acoustic Neuroma) Resection

This video demonstrates the operative setup and surgical steps of a middle fossa approach for the resection of vestibular schwannoma (acoustic neuroma).

Authors:

Cameron C. Wick, MD (cameron.wick@wustl.edu) 1

Samuel L. Barnett, MD (sam.barnett@utsouthwestern.edu) 2

J. Walter Kutz Jr., MD (walter.kutz@utsouthwestern.edu) 3

Brandon Isaacson, MD (brandon.isaacson@utsouthwestern.edu) 3

1 – Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO

2 – Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX

3- Department of Otolaryngology – Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX

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