Ahead of Print: Presigmoidal Suprabulbar Infralabyrinthine Approach

Background: Jugular foramen tumors are rare and challenging lesions for skull base surgeons due to their difficult operative accessibility. Various surgical approaches to the jugular foramen have been described to overcome the morbidity of standard petrosectomy.

Objective: To describe the surgical anatomy of a novel route to the jugular foramen without opening the fallopian canal: the navigated tailored presigmoidal suprabulbar infralabyrinthine approach.

Methods: Ten cadaver heads were dissected under navigational guidance on both sides to examine the advantages and limitations of the presigmoidal suprabulbar infralabyrinthine approach without opening the fallopian canal. Mastoidectomy was performed using a high-speed drill. Under navigation guidance, the sigmoid sinus, jugular bulb, posterior semicircular canal, and fallopian canal were located and preserved. The jugular foramen with the extradural part of the IXth, Xth, and XIth nerve were identified.

Ahead of Print: Intracranial Facial Nerve Through Different Surgical Windows

Background: The facial nerve has a short intracranial course but crosses critical and frequently accessed surgical structures during skull base surgery. When performing approaches to complex intracranial regions, it is essential to understand the nerve’s conventional and topographical anatomy from different surgical perspectives as well as its relationship with surrounding structures.

Objective: To describe the entire intracranial course of the facial nerve as observed through different neurosurgical approaches and to provide an analytical evaluation of the degree of nerve exposure achieved with each approach.

Methods: Anterior petrosectomies (middle fossa, extended middle fossa), posterior petrosectomies (translabyrinthine, retrolabyrinthine, transcochlear), a retrosigmoid, a far lateral, and anterior transfacial (extended maxillectomy, mandibular swing) approaches were performed on 10 adult cadaveric heads (20 sides). The degree of facial nerve exposure achieved per segment for each approach was assessed and graded independently by three surgeons.

Ahead of Print: Smell and Skull Base Surgery

Background: Endoscopic skull base surgery is now the preferred treatment option to remove skull base tumors.

Objective: To evaluate the patient’s sense of smell and mucociliary clearance time (MCT) after skull base surgery.

Methods: Patients with pituitary adenoma underwent a Transnasal Transphenoidal Endoscopic Approach (TTEA Group, N=36), while patients with other benign parasellar tumors underwent an Expanded Endonasal Approach (EEA Group, N=14) with a vascularized septal flap (VSF). Assessment of symptoms (Visual Analogue Scale, VAS), olfactometry (Barcelona Smell Test, BAST-24), and MCT (Saccharin test) were performed before and 3 months after surgery.

Ahead of Print: Middle Fossa Approach for CG

Background: Cholesterol granulomas (CG) of the petrous apex (PA) are rare, benign expanding lesions. Surgical treatment is recommended for patients with symptomatic disease; however, the optimal surgical procedure is still controversial due to high recurrence rates. The main treatment strategy is divided into drainage and complete resection.

Objective: We advocate radical resection of the lesion by the middle fossa approach and reconstruction with a vascularized galeofascial flap.

Methods: A 10-year retrospective case review of 17 patients undergoing surgical treatment of PA CGs between 2000 and 2010 was undertaken. Operative outcomes and surgical complications were analyzed. In addition, our operative method and the related anatomy are described from cadaveric dissections.

Ahead of Print: Endoscopic Endonasal Optic Canal Decompression in Suprasellar Meningiomas

Background: Suprasellar meningiomas often invade the optic canals (OC). The feasibility of removing these tumors through a minimal access endonasal route has been demonstrated but the importance, safety, and timing of OC exploration and decompression is not well-described.

Objective: To create a simple decision-tree algorithm for OC exploration and decompression in the endonasal, endoscopic surgery for planum sphenoidale (PS) and tuberculum sella (TS) meningiomas.

Methods: We identified a consecutive series of 8 PS and TS meningiomas resected endonasally. ‘Late” OC exploration and decompression was performed in 4/8 patients. Extent of resection, visual outcome, and complications were recorded.