Ahead of Print: Modified Subtemporal Approach with Hearing Preservation

Screen Shot 2014-02-20 at 11.20.30 AMBackground: The microsurgical management of aneurysms in the interpeduncular and ambient cisterns remains challenging. The classic subtemporal approach has several limitations.

Objective: To present a modification of this approach that allows for broader exposure with hearing preservation.

Methods: We retrospectively reviewed our clinical database between August 2007 and February 2012 for all patients who underwent a modified subtemporal partial postero-superior petrosectomy. Clinical data, complications, and post-operative head CT scans were analyzed. Improvement in the angle of view acquired by the new approach was measured using the OsiriX(R) 3-D rendering software and was compared to that obtained from the subtemporal approach. Similar methods were used to study improvement in the angle of view in head CT scans of randomly selected control patients.

Results: Five patients underwent a modified subtemporal approach for posterior circulation aneurysm clipping. All patients were female with a mean age of 49.8 years. Mean aneurysm size was 5.75mm. Mean improvement in the angle of view was 17.52 degrees in the study group (n = 5) and 11.7 degrees in the control group (n= 10). Hearing was completely preserved in 3 patients. One patient had a sub-clinical conductive hearing loss and 1 patient was not assessed formally at follow-up, but had no hearing complaints. No neurological sequelae were recorded.

Conclusion: Our modified subtemporal approach appears to be safe and provides increased angle of view with minimal additional operative time and with low risk to hearing. This approach may expand this surgical corridor and reduce the need for temporal lobe retraction.

From: Enhancement of the Subtemporal Approach by Partial Postero-Superior Petrosectomy with Hearing Preservation by Bendok et al.

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