Short CommunicationTranslabyrinthine approach to internal auditory meatus: A retrospective study
Introduction
Ear and the lateral skull base surgery is challenging and yet fascinating for a neuro-otologist. A thorough knowledge of the complex anatomy is indispensable for the surgeon in order to provide the best possible care to his patients and also to improve his surgical skills. Lateral skull base approaches can be broadly classified into: (1) those through the otic capsule, (2) those conserving the otic capsule and (3) a combination of the two.
The translabyrinthine approach, through otic capsule, offers an excellent anatomical view and direct approach of the cerebellopontine angle (CPA) and internal auditory meatus (IAM) with functional preservation of the facial nerve and minimal morbidity.1
In the past two and half years, we have operated on cases of vestibular schwannoma, facial nerve schwannoma, Meniere's disease with refractory vertigo via translabyrinthine approach. Apart from this, we encountered a rare case of tuberculoma of the IAM. The aim of the study was to highlight the present day indications for translabyrinthine approach to IAM from a neuro-otologist perspective. Additionally, it addresses the traditional labyrinthectomy and identifies a time-efficient version.
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Material and Methods
Our study was a retrospective study, conducted at a tertiary care centre in southern India, and comprised of cohort of 7 patients who underwent translabyrinthine approach from January 2012 to June 2015. Institutional research ethics board approval was obtained. Records were obtained from our medical records department. All relevant history, clinical examination, investigations, and surgical finding were noted.
Results
There were a total of 7 patients who underwent translabyrinthine approach at our centre. The clinical details are as listed in Table 1. At the stage of clinical diagnosis there were total of 4 cases of vestibular schwannoma; 1 case of facial nerve schwannoma (Fig. 1); 1 case of IAM stenosis with facial nerve paresis (Fig. 2); and lastly there was 1 case of Meniere's disease with intractable vertigo (non controlled with medical management and intra tympanic injection of gentamicin as listed in
Discussion
The labyrinthine bone in humans is the densest or the hardest bone while its membranous portion is like a network of complex path.2 Hence, the term labyrinth to this part of temporal bone symbolising a hard path or a maze.
The translabyrinthine approach was first described by Panse in 1904. Later in 1912, Quix used this approach to resect a tumour involving the IAM and CPA. However, it was not until 1964, when House published 47 resections with no mortalities the approach was truly popularised.3
Conclusion
The article presents different clinical situations where this approach can be suitably utilised has been dealt with via a series of cases encountered at our centre. The article presents a comprehensive review of the translabyrinthine approach to IAM from the perspective of a neuro-otologist. However, the treatment and approach have to be individualised and stringent selection criteria in deciding on the appropriate surgical management is crucial.
Conflicts of interest
The authors have none to declare.
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