ABSTRACT
PURPOSE: The narrow supralabyrinthine space affects surgical procedures. To study the effect of temporary transposition of geniculate ganglion of facial nerve versus nontransposition on lesion recurrence and facial nerve function in patients with petrous bone cholesteatoma. METHODS: A total of 18 patients with petrous bone cholesteatoma involving the facial nerve were treated in our hospital from November 2016 to March 2023. The main surgical method is the extended supralabyrinthine approach assisted by a microscope and an endoscope. We collected and retrospectively analyzed their medical records. RESULTS: Temporary facial nerve transposition was performed in five patients, and nontransposition was performed in 13 patients. Cholesteatoma recurred in three patients with facial nerve nontransposition, whereas none in patients with facial nerve transposition. In this study, except for one case with a second operation, postoperative facial paralysis in other cases was improved to varying degrees, and there was no significant difference between the two groups. CONCLUSION: Temporary transposition of geniculate ganglion of facial nerve will not affect the postoperative nerve function of patients and can reduce the possibility of cholesteatoma recurrence of the petrous bone.
Subject(s)
Cholesteatoma , Endoscopy , Facial Nerve , Petrous Bone , Humans , Petrous Bone/surgery , Male , Female , Retrospective Studies , Adult , Endoscopy/methods , Middle Aged , Cholesteatoma/surgery , Facial Nerve/surgery , Aged , Geniculate Ganglion/surgery , Facial Paralysis/surgery , Facial Paralysis/etiology , Young Adult , Recurrence , Adolescent , Treatment Outcome , Microsurgery/methodsABSTRACT
PURPOSE: A variety of lesions could arise from the GG area, or extend into this region from adjacent sites. The management of perigeniculate lesions includes observation, surgery, and radiation, according to the nature, the size of the lesion, and the accompanying symptoms. Preliminary experiences on the exclusive transcanal endoscopic approach to the GG area have shown safety and feasibility avoiding of any postauricular incision, or brain manipulation. The experience from two referral centers on patients treated for a GG lesion with a totally endoscopic approach is herein reported. METHODS: Data about patients who underwent exclusive endoscopic approach to the GG area at the Otolaryngology Departments of the University Hospitals of Modena and Bologna between May 2017 and February 2022 were retrospectively collected. RESULTS: The total number of patients included in our study was 11. 10 patients (91%) had progressive unilateral facial paralysis and 1 patient (11%) presented with chronic otorrhea. The mean largest diameter of the treated lesions was of 8 mm. The resection was extended to the fundus of the IAC in 2 patients (expanded approach). The remaining 9 patients (82%) underwent partial ossicular replacement prosthesis (PORP). No major complications occurred. Facial nerve outcomes were good in all patients and the mean ABG worsened from 12 dB pre-operatively to 22 dB post-operatively. CONCLUSIONS: The exclusively endoscopic approach to GG lesions represents a viable alternative to traditional microscopic approaches and may be included in the armamentarium of ear surgeons.
Subject(s)
Ear Diseases , Geniculate Ganglion , Humans , Geniculate Ganglion/surgery , Retrospective Studies , Endoscopy , Facial Nerve , Ear Diseases/surgery , Treatment OutcomeABSTRACT
Geniculate ganglion hemangioma (GGH) is rarely presented in the neurosurgical literature. It extends extradurally on the middle fossa floor and displaces the intratemporal part of the facial nerve. Surgical treatment is advisable at early symptoms. Proposed techniques include fascicular-sparing resection or nerve interruption with grafting. No definitive conclusions exist about the superiority of a certain technique in preserving facial nerve integrity and function. Through the description of a surgically managed symptomatic GGH, we herein discuss literature data about the surgical results of fascicular-sparing resection versus grafting. A PRISMA-based literature search was performed on the PubMed database. Only articles in English and published since 1990 were selected and furtherly filtered based on the best relevance. Statistical comparisons were performed with ANOVA. One hundred sixteen GGHs were collected, 56 were treated by fascicular-sparing resection, and 60 were treated by grafting. The facial function was improved, or unchanged, in 53 patients of the fascicular-sparing group and 30 patients of the grafting one. Sixty-five patients achieved a good (House-Brackmann (HB) grade III) postoperative facial outcome, of which 47 and 18 belonged to the fascicular-sparing and grafting group, respectively. Greater efficacy of the fascicular-sparing technique in the achievement of a better facial outcome was found (p = 0.0014; p = 0.0022). A surgical resection at the earliest symptoms is critical to preserve the facial nerve function in GGHs. Fascicular-sparing resection should be pursued in symptomatic cases with residual facial function (I-III HB). Conversely, grafting has a rationale for higher HB grades (V-VI). Broader studies are required to confirm these findings and turn them into new therapeutic perspectives.
Subject(s)
Cranial Nerve Neoplasms , Facial Paralysis , Hemangioma , Humans , Geniculate Ganglion/surgery , Treatment Outcome , Retrospective Studies , Cranial Nerve Neoplasms/surgery , Facial Nerve/surgery , Hemangioma/surgery , Facial Paralysis/surgeryABSTRACT
OBJECTIVE: The current study evaluated the effectiveness of endoscopic transcanal facial nerve decompression in patients with post-traumatic facial nerve paralysis. METHODS: This retrospective study included 10 patients with post-traumatic complete facial nerve paralysis who underwent endoscopic transcanal facial nerve decompression. The surgical technique was explained step by step, and the surgical complications, hearing status and facial nerve function 12 months post-operatively were reported. RESULTS: Endoscopic transcanal facial nerve decompression allowed exposure of the geniculate ganglion to the mastoid segment. The facial nerve function improved from House-Brackmann grade VI to grades I and II in 8 of 10 (80 per cent) patients, and 2 patients experienced partial recovery (House-Brackmann grades III and IV). No severe complication was reported. CONCLUSION: Endoscopic transcanal facial nerve decompression, involving the nerve from the geniculate ganglion to the mastoid segment, is a safe and effective approach in patients with post-traumatic facial nerve paralysis.
Subject(s)
Facial Nerve Injuries , Facial Paralysis , Humans , Facial Nerve/surgery , Geniculate Ganglion/surgery , Mastoid/surgery , Retrospective Studies , Facial Nerve Injuries/surgery , Facial Nerve Injuries/complications , Paralysis/complications , Paralysis/surgery , Facial Paralysis/etiology , Facial Paralysis/surgery , Decompression, Surgical/adverse effects , Decompression, Surgical/methodsABSTRACT
Objective:Summarize the safety and feasibility of highly selective vidian neurectomy guided by the palatovaginal canal. Methods:Hypothermal plasma surgery was performed on 53 patients with perennial allergic rhinitis ï¼PARï¼. Remove the soft tissue covering the anterior wall of the sphenoid process of palatine bone using the Coblation system. Find the palatovaginal canal and cut off the neurovascular bundle in the palatovaginal canal. Expose the anterior orifice of the vidian canal and cut off the vidian nerve. Results:53 PAR patients have conducted the novel vidian neurectomy without sphenopalatine artery trunk damage. No secondary hemorrhage and hard palate numbness happened. The symptoms of nasal obstruction, sneeze, nasal discharge, and rhinocnesmus were relieved significantly. Conclusion:The simple and safe approach of highly selective vidian neurectomy guided by the palatovaginal canal provides an alternative surgical option for clinicians.
Subject(s)
Rhinitis, Allergic, Perennial , Sphenoid Sinus , Denervation , Geniculate Ganglion/surgery , Humans , Sphenoid Bone/innervation , Sphenoid Sinus/surgeryABSTRACT
Objective: To investigate the clinical characteristics, differential diagnosis, treatments and prognosis of facial nerve hemangioma and schwannoma at genicular ganglion, so as to provide reference for clinical diagnosis and treatments of facial nerve tumor at genicular ganglion. Methods: Clinical data of 13 patients with facial nerve tumors at genicular ganglion confirmed by postoperative pathology in the Ninth People's Hospital affiliated to Shanghai Jiaotong University School of Medicine from March 2018 to April 2020 were retrospectively analyzed, including seven cases of hemangioma and six cases of schwannoma. There were eight males and five females. Their ages ranged from 20 to 65, with an average age of 40. The course of disease ranged from 3 to 118 months, with an average of 52 months. All the patients underwent preoperative HRCT of the temporal bone and facial nerve dynamic contrast-enhanced(DCE) MRI examinations. All the patients had detailed surgical procedures and at least one-year postoperative follow-up. Results: On HRCT of the temporal bone, (4/7) hemangioma at geniculate ganglion showed characteristic honeycomb appearance, while 6/6 schwannoma and 3/7 hemangiomas showed expansive bone changes. On DCE-MRI, geniculate ganglion hemangioma (7/7) showed characteristic "point-to-surface" enhancement, and schwannoma (6/6) showed characteristic "face-to-surface" enhancement. For five hemangioma-patients with HB-â ¡-â £ before surgery, the facial nerve anatomy was completely preserved through transcanal endoscopic approach(TEA), and the facial nerve function improved one year after surgery (two cases of HB-I, two cases of HB-â ¡, and one case of HB-â ¢). For two patients, with preoperative facial nerve function HB-â ¤-â ¥, since their tumors was inseparable from the nerves, they were performed with facial nerve anastomosis during the surgery, and the facial nerve function was improved to HB-â £ level one year after surgery. For six patients with meningioma whose facial nerve function was greater than or equal to HB-â ¢, based on the preoperative hearing level, the involved segments, and duration of facial paralysis, three of them were conducted surgeries through middle cranial fossa approach, one by translabyrinthine approach, and one via mastoid approach. Two patients among them with complete facial paralysis over three years preoperatively were not performed facial nerve anastomosis after total resections of the tumors, and there was no improvement in facial nerve function one year after surgery. Three patients underwent facial nerve anastomosis after total tumor resections, and their facial nerve function was HB-â ¢ in one patient, HB-â £ in two patients one year after surgery. One patient (preoperative HB-â ¢) had a normal hearing level preoperatively, and the tumor involved the labyrinth segment. To protect the hearing, partial tumor was resected through the middle cranial fossa approach, and facial nerve function improved to HB-â ¡ one year after surgery. Conclusions: Temporal bone HRCT combined with DCE-MRI are useful for the differential diagnosis of hemangioma and schwannoma at geniculate ganglion and provide references for preoperative clinical decision makings. It is extremely necessary to select the appropriate surgical approach based on the patient's hearing and involved segments. For geniculate ganglion hemangioma, early surgery can improve the possibilities of anatomical integrity of facial nerve, thereby improving facial nerve function postoperatively.TEA is a kind of surgical method worth consideration, with the characteristics of minimally invasive, favorable postoperative features, and so on. For schwannoma, one-stage functional reconstruction of the facial nerve is recommended during the resection of the tumors because of the inevitable damage to the anatomical integrity of the facial nerve.
Subject(s)
Cranial Nerve Neoplasms , Facial Nerve Diseases , Facial Paralysis , Hemangioma , Meningeal Neoplasms , Neurilemmoma , Adult , Child, Preschool , China , Cranial Nerve Neoplasms/surgery , Diagnosis, Differential , Facial Nerve/surgery , Facial Nerve Diseases/diagnosis , Facial Paralysis/diagnosis , Female , Geniculate Ganglion/pathology , Geniculate Ganglion/surgery , Hemangioma/diagnosis , Hemangioma/surgery , Humans , Infant , Male , Meningeal Neoplasms/complications , Meningeal Neoplasms/diagnosis , Meningeal Neoplasms/pathology , Neurilemmoma/surgery , Retrospective StudiesABSTRACT
PURPOSE: The aim of this study is to evaluate the feasibility and the safety of a novel, alternative method for bone tissue management in facial nerve decompression by a middle cranial fossa approach. Several applications of Piezosurgery technology have been described, and the technique has recently been extended to otologic surgery. The piezoelectric device is a bone dissector which, using micro-vibration, preserves the anatomic integrity of soft tissue thanks to a selective action on mineralized tissue. METHODS: An anatomic dissection study was conducted on fresh-frozen adult cadaveric heads. Facial nerve decompression was performed by a middle cranial fossa approach in all specimens using the piezoelectric device under a surgical 3D exoscope visualization. After the procedures, the temporal bones were examined for evidence of any injury to the facial nerve or the cochleovestibular organs. RESULTS: In all cases, it was possible to perform a safe dissection of the greater petrosal superficial nerve, the geniculate ganglion, and the labyrinthine tract of the facial nerve. No cases of semicircular canal, cochlea, or nerve damage were observed. All of the dissections were carried out with the ultrasonic device without the necessity to replace it with an otological drill. CONCLUSION: From this preliminary study, surgical decompression of the facial nerve via the middle cranial fossa approach using Piezosurgery seems to be a safe and feasible procedure. Further cadaveric training is recommended before intraoperative use, and a wider case series is required to make a comparison with conventional devices.
Subject(s)
Facial Nerve , Geniculate Ganglion , Adult , Cadaver , Cranial Fossa, Middle/anatomy & histology , Cranial Fossa, Middle/surgery , Decompression, Surgical/methods , Facial Nerve/anatomy & histology , Facial Nerve/surgery , Geniculate Ganglion/anatomy & histology , Geniculate Ganglion/surgery , Humans , Semicircular Canals/surgery , UltrasonicsABSTRACT
PURPOSE: To describe the suprameatal-transzygomatic root endoscopic approach (STEA) to the geniculate ganglion (GG), the labyrinthine facial nerve (FN) and epitympanum. METHODS: The feasibility and limits of the STEA, maintaining the integrity of the ossicular chain, were analysed. Ten human cadaveric ears were dissected. Step-by-step description of the technique and relevant measurements were taken during the approach. The visualization and surgical working field on the anterior and posterior medial epitympanum, GG, greater superficial petrosal nerve, the labyrinthine FN and suprageniculate area were evaluated. The range of motion through the approach and the rate of the decompression of the GG and the labyrinthine portion of the FN were assessed as well. CT-scan measurements were compared with those obtained during the dissection. RESULTS: A complete exploration of the epitympanum was possible in every specimen. Decompression of the GG and first portion of the FN was achieved without any trauma to the ossicular chain in nine ears. The endoscope movements were mainly limited by the distance between bony buttress-short process of the incus-tegmen. The working space, during GG and labyrinthine FN decompression, was limited by the distance between malleus head-medial epitympanic wall and malleus head-GG. Radiologic measurements were consistent with those obtained during the dissections. CONCLUSION: The STEA is a promising minimally invasive approach for decompression of the GG and FN's labyrinthine portion. The applications of this corridor include the exploration and surgery of the medial epitympanum, preserving the ossicular chain.
Subject(s)
Ear, Inner , Geniculate Ganglion , Ear, Inner/diagnostic imaging , Ear, Inner/surgery , Ear, Middle/surgery , Endoscopy , Facial Nerve/diagnostic imaging , Facial Nerve/surgery , Geniculate Ganglion/diagnostic imaging , Geniculate Ganglion/surgery , HumansABSTRACT
Within the last ten years, advances in genetically encoded calcium indicators (GECIs) have promoted a revolution in in vivo functional imaging. Using calcium as a proxy for neuronal activity, these techniques provide a way to monitor the responses of individual cells within large neuronal ensembles to a variety of stimuli in real time. We, and others, have applied these techniques to image the responses of individual geniculate ganglion neurons to taste stimuli applied to the tongues of live anesthetized mice. The geniculate ganglion is comprised of the cell bodies of gustatory neurons innervating the anterior tongue and palate as well as some somatosensory neurons innervating the pinna of the ear. Imaging the taste-evoked responses of individual geniculate ganglion neurons with GCaMP has provided important information about the tuning profiles of these neurons in wild-type mice as well as a way to detect peripheral taste miswiring phenotypes in genetically manipulated mice. Here we demonstrate the surgical procedure to expose the geniculate ganglion, GCaMP fluorescence image acquisition, initial steps for data analysis, and troubleshooting. This technique can be used with transgenically encoded GCaMP, or with AAV-mediated GCaMP expression, and can be modified to image particular genetic subsets of interest (i.e., Cre-mediated GCaMP expression). Overall, in vivo calcium imaging of geniculate ganglion neurons is a powerful technique for monitoring the activity of peripheral gustatory neurons and provides complementary information to more traditional whole-nerve chorda tympani recordings or taste behavior assays.
Subject(s)
Calcium/metabolism , Geniculate Ganglion/physiology , Neurons/physiology , Taste/physiology , Anesthesia , Animals , Geniculate Ganglion/surgery , Immobilization , Mice , Physical Stimulation , Taste Buds/physiology , TracheotomyABSTRACT
OBJECTIVES/HYPOTHESIS: Although vidian neurectomy (VN) is associated with decreased lacrimation, its impact on dry eye quality-of-life is not well-defined. Endoscopic endonasal transpterygoid approaches (EETA) may require vidian nerve sacrifice. STUDY DESIGN: A prospective cohort trial. METHODS: A prospective trial evaluating VN during EETA on lacrimation by phenol red thread testing and dry eye severity by the five-item Dry Eye Questionnaire (DEQ-5) was performed. Preservation of the contralateral vidian nerve allowed comparison between the eye subjected to VN and the control eye postoperatively. RESULTS: Twenty-one subjects were enrolled with no preoperative difference in lacrimation between eyes (P = .617) and overall mild dry eye severity. Although the control eye had no difference in lacrimation pre- and postoperatively, decreased tearing was noted in the VN eye at 1 month (20.8 mm vs. 15.8 mm, P = .015) and at 3 months (23.2 mm vs. 15.8 mm, P = .0051) postoperatively. Overall, no difference was noted in the DEQ-5 score for dry eye severity between the pre- and postoperative measures. However, six patients were noted to have moderate to severe dry eye severity postoperatively and five of these six had decreased lacrimation (<20 mm) preoperatively. Patients with decreased tearing preoperatively demonstrated significantly worse postoperative DEQ-5 scores when compared to patients with normal tearing (P < .0056). CONCLUSIONS: VN during EETA results in decreased tearing but is not associated with increased dry eye severity overall. However, patients with decreased tearing preoperatively are at risk for increased dry eye severity and should be counseled for this risk. LEVEL OF EVIDENCE: 2 Laryngoscope, 131:1487-1491, 2021.
Subject(s)
Denervation/methods , Geniculate Ganglion/surgery , Lacrimal Apparatus Diseases/surgery , Natural Orifice Endoscopic Surgery/methods , Quality of Life , Adult , Humans , Lacrimal Apparatus/innervation , Lacrimal Apparatus Diseases/complications , Lacrimal Apparatus Diseases/diagnosis , Lacrimal Apparatus Diseases/psychology , Male , Middle Aged , Prospective Studies , Severity of Illness Index , Treatment Outcome , Young AdultABSTRACT
PURPOSE: The aim of our study was to determine guide parameters for clinicians by morphometric assessment of important landmarks on cranium intended for Vidian nerve surgery. METHODS: For the study, 23 half-skull bases, 40 skull bases and 40 skulls were obtained from the Department of Anatomy, Ege University Medicine Faculty. The vertical distances were measured using a digital caliper to the nearest 0.01 mm. RESULTS: The anterior opening of the Vidian canal (pterygoid canal) was observed as oval shaped on 57 specimens (31.1%), funnel shaped on 58 specimens (31.7%), round shaped on 64 specimens (35%) and septated on 4 specimens (2.2%). Vidian canal was embedded into the body of sphenoid on 55 specimens (52.4%) (embedded type) and protruded to sphenoidal sinus on 50 specimens (47.6%) (protruded type). 21 specimens of 50 were partial and 29 specimens were total. There were dehiscences on 21 specimens of 50 protruded type on the base of sphenoidal sinus (20%). Anterior opening of the Vidian canal was assessed according to medial lamina of pterygoid process. It was located medially in 169 of the specimens (92.3%) and laterally in 14 specimens (7.7%). CONCLUSION: Vidian canal and Vidian nerve are deeply located structures on skull. Vidian canal and surrounding structures are important landmarks for microsurgery and endoscopic approaches to Vidian nerve. We consider that knowledge of anatomical features of Vidian canal and preoperative imaging by CT (computed tomography) will be supportive when choosing and planning a safe surgical approach.
Subject(s)
Anatomic Landmarks , Geniculate Ganglion/surgery , Neurosurgical Procedures/methods , Skull/anatomy & histology , Sphenoid Sinus/anatomy & histology , Endoscopy/adverse effects , Endoscopy/methods , Geniculate Ganglion/anatomy & histology , Humans , Microsurgery/adverse effects , Microsurgery/methods , Neurosurgical Procedures/adverse effects , Patient Care PlanningABSTRACT
BACKGROUND: At present, the effect of operation intervention on pulmonary function is not clear in patients with allergic rhinitis and chronic rhinosinusitis with nasal polyps (AR&CRSwNP). This study was conducted to investigate the effect of vidian neurectomy on pulmonary function and airway hyperresponsiveness (AHR) in patients with AR&CRSwNP. METHODS: The incidences of AHR, bronchial asthma (BA) and pulmonary function impairment in 112 patients with AR&CRSwNP were investigated. Subsequently, we evaluated the outcome of vidian neurectomy and its effect on pulmonary function and AHR. Furthermore, we explored the correlation between postoperative level of eosinophilic cationic protein (ECP) and the changes of pulmonary function indices or dose of methacholine. RESULTS: In this study, the incidences of pulmonary function impairment, bronchial asthma, and AHR in patients with AR&CRSwNP were 61.61%, 69.64%, and 66.96%, respectively. Particularly, vidian neurectomy effectively alleviated nasal symptoms, improved pulmonary function, and reduced AHR in AR&CRSwNP patients. Furthermore, the postoperative level of ECP, IgE, Interleukin-4 and Interleukin-IL-5 was dramatically decreased, and there was an obvious inverse correlation between ECP level and pulmonary function index or dose of methacholine. CONCLUSIONS: Vidian neurectomy is effective in alleviating nasal symptoms, improving pulmonary function, and reducing the risk of AHR of patients with AR&CRSwNP by decreasing the level of ECP.
Subject(s)
Denervation/methods , Geniculate Ganglion/surgery , Nasal Polyps/surgery , Otorhinolaryngologic Surgical Procedures/methods , Rhinitis, Allergic/surgery , Sinusitis/surgery , Adult , Bronchial Hyperreactivity/immunology , Bronchial Hyperreactivity/physiopathology , Bronchial Provocation Tests , Chronic Disease , Eosinophil Cationic Protein/immunology , Female , Forced Expiratory Volume , Humans , Immunoglobulin E/immunology , Interleukin-4/immunology , Interleukin-5/immunology , Male , Middle Aged , Nasal Polyps/immunology , Nasal Polyps/physiopathology , Postoperative Complications/epidemiology , Respiratory Hypersensitivity/immunology , Respiratory Hypersensitivity/physiopathology , Rhinitis, Allergic/immunology , Rhinitis, Allergic/physiopathology , Sinusitis/immunology , Sinusitis/physiopathology , Treatment Outcome , Vital CapacityABSTRACT
PURPOSE: Vidian neurectomy is a surgical procedure applied to different pathological conditions, including chronic rhinitis and sphenopalatine neuralgia. The choice of the correct surgical approach depends upon the possible protrusion of Vidian nerve into the sphenoid sinuses. The present study analyzes the possible relationship between protrusion of Vidian nerve and volume of sphenoid sinuses. METHODS: In total, 320 maxillofacial CT-scans were retrospectively assessed. Subjects equally divided among males and females (age range 18-94 years) were divided into three groups according to the profile of Vidian nerve protrusion: type 1: Vidian nerve inside the sphenoid corpus; type 2: partially protruding into the sphenoid sinus; and type 3: entirely protruding into the sphenoid sinus through a stalk. Volume of sphenoid sinuses was extracted through the ITK-SNAP-free software and automatically calculated. Possible statistically significant differences in prevalence of the three types between males and females were assessed through Chi-squared test (p < 0.05). Differences in volume of sphenoid sinuses in subjects included within the three types were assessed through one-way ANOVA test (p < 0.05), separately for males and females. RESULTS: Type 2 was the most prevalent (46.5%), followed by type 1 (38.8%) and type 3 (14.7%), without significant differences according to sex (p > 0.05). Volume significantly increased passing from type 1 to type 3 both in males (p < 0.01) and in females (p < 0.01). CONCLUSIONS: The results prove the existence of a strict relationship between sphenoid sinuses pneumatization and protrusion of the Vidian canal and give a contribution to the knowledge of this important anatomical variant in endoscopic surgery.
Subject(s)
Anatomic Variation , Denervation/methods , Geniculate Ganglion/anatomy & histology , Sphenoid Sinus/innervation , Adolescent , Adult , Aged , Aged, 80 and over , Clinical Decision-Making , Facial Neuralgia/etiology , Facial Neuralgia/surgery , Female , Geniculate Ganglion/diagnostic imaging , Geniculate Ganglion/surgery , Humans , Imaging, Three-Dimensional , Male , Middle Aged , Retrospective Studies , Rhinitis/etiology , Rhinitis/surgery , Sphenoid Sinus/diagnostic imaging , Tomography, X-Ray Computed , Young AdultABSTRACT
OBJECTIVES/HYPOTHESIS: Surgical management of nasopharyngeal tumors has evolved in the endoscopic era. Lateral exposure remains difficult especially near the petrous internal carotid artery and bony Eustachian tube (ET). Our study examines the need to sacrifice the vidian and greater palatine nerves in order to successfully perform en bloc endoscopic nasopharyngectomy. METHODS: Four cadaveric specimens (eight sides) were dissected bilaterally using a binarial, extended, endoscopic endonasal approach (EEA). Nasopharyngectomy was completed including an extended transptyergoid approach for resection of the cartilaginous ET at its junction with the bony ET. Dissection was attempted without sacrifice of the vidian or palatine nerves. RESULTS: Successful en bloc nasopharyngectomy combined with a nerve-sparing transpterygoid approach was achieved in all specimens with successful preservation of the palatine and vidian nerves. The approach provided exposure of foramen lacerum, the petrous carotid, foramen spinosum, and foramen ovale as well as all segments of the cartilaginous Eustachian tube, Meckel's cave and the parapharyngeal carotid. There was no inadvertent exposure or injury of the internal carotid artery. CONCLUSION: Endoscopic nasopharyngectomy combined with a nerve-sparing transpterygoid approach allows for en bloc resection of the cartilaginous Eustachian tube and nasopharyngeal contents with broad skull base exposure and preservation of the internal carotid artery, vidian and palatine nerves. LEVEL OF EVIDENCE: VI Laryngoscope, 130:2343-2348, 2020.
Subject(s)
Endoscopy/methods , Nasal Surgical Procedures/methods , Nasopharyngeal Neoplasms/surgery , Pharyngectomy/methods , Cadaver , Dissection , Eustachian Tube/surgery , Geniculate Ganglion/anatomy & histology , Geniculate Ganglion/surgery , Humans , Palate/innervation , Sphenoid Bone/surgerySubject(s)
Humans , Female , Middle Aged , Cranial Nerve Neoplasms/surgery , Natural Orifice Endoscopic Surgery/methods , Geniculate Ganglion/surgery , Neurilemmoma/surgery , Magnetic Resonance Imaging , Cranial Nerve Neoplasms/diagnostic imaging , Diagnosis, Differential , Geniculate Ganglion/diagnostic imaging , Neurilemmoma/diagnostic imagingABSTRACT
Hemangioma of the facial nerve (FN) is a very rare benign tumor whose origin is the vascular plexi that surround the nerve. The transpetrous, retrosigmoid, and middle cranial fossa (MCF) routes are the traditional and most widely used approaches to reach these lateral skull base neoformations. However, this very complex region can be reached through an exclusive transcanal endoscopic procedure in selected cases. One of these was a 42-year-old patient who had been presenting a worsening left FN paralysis (grade VI according to the House-Brackmann scale at the time of visit) for 22 months without a history of trauma or infection. Radiological studies showed a lesion in the region of the geniculate ganglion. A suprageniculate endoscopic approach was performed to remove the lesion, with the sacrifice of the FN and a simultaneous hypoglossal-facial anastomosis. The aim of this minimally invasive surgery is the complete excision of the disease, maintaining the hearing function intact and restoration of facial function, whenever possible, avoiding more invasive approaches.
Subject(s)
Facial Nerve/transplantation , Geniculate Ganglion/blood supply , Geniculate Ganglion/surgery , Hemangioma/surgery , Adult , Anastomosis, Surgical , Audiometry, Pure-Tone , Cranial Fossa, Middle/diagnostic imaging , Cranial Fossa, Middle/pathology , Cranial Fossa, Middle/surgery , Ear, Middle/pathology , Ear, Middle/surgery , Endoscopy/methods , Facial Nerve/blood supply , Facial Nerve/pathology , Facial Paralysis/etiology , Geniculate Ganglion/diagnostic imaging , Geniculate Ganglion/pathology , Hearing/physiology , Hemangioma/pathology , Humans , Minimally Invasive Surgical Procedures/methods , Treatment OutcomeSubject(s)
Cranial Nerve Neoplasms/surgery , Geniculate Ganglion/surgery , Natural Orifice Endoscopic Surgery/methods , Neurilemmoma/surgery , Cranial Nerve Neoplasms/diagnostic imaging , Diagnosis, Differential , Female , Geniculate Ganglion/diagnostic imaging , Humans , Magnetic Resonance Imaging , Middle Aged , Neurilemmoma/diagnostic imagingABSTRACT
Objective:The aim of this study is to investigate the effect of highly selective branches neurotomy of vidian nerve with low temperature plasma on the level of vasoactive intestinal peptide in nasal mucosa of patients with allergic rhinitis. Method:Fifty patients with allergic rhinitis were selected as the experimental group. At the same time, 50 normal adults in our hospital were selected as the control group. Highly selective branches neurotomy of vidian nerve with low temperature plasma was performed to observe the changes of vascular intestinal peptide levels in patients with nasal mucosa and the clinical efficacy. Result:Fifty patients with allergic rhinitis were treated with highly selective branches neurotomy of vidian nerve with low temperature plasma. 28 cases have significant effect and the curative effect was 64.3%-92.1% (average was 77.4±4.5)%; 19 were effective and the therapeutic effect was 31.2%-56.4%, with an average of (43.2±2.9)%; only 3 cases were ineffective, and the therapeutic effect was less than 30%. There was significant difference between the two groups after treatment (P<0.05). The optical density of vasoactive intestinal peptide was (1 723.3±215.4) and (2 732.3±324.5) in the preoperative and postoperative groups, respectively, with significant differences (P<0.05). The optical density of vasoactive intestinal peptide in the control group was (1 855.4±429.3), which was significantly different from that in the experimental group before operation (P<0.05). The difference between the control group and the experimental group after operation have no statistically significant (P>0.05). Conclusion:Highly selective branches neurotomy of vidian nerve with low temperature plasma can significantly reduce the level of vasoactive intestinal peptide in nasal mucosa of patients with allergic rhinitis, alleviate the symptoms of nasal congestion and paroxysmal sneezing, and improve the prognosis of patients.
Subject(s)
Nasal Mucosa/metabolism , Parasympathetic Nervous System/surgery , Rhinitis, Allergic/surgery , Vasoactive Intestinal Peptide/metabolism , Adult , Geniculate Ganglion/surgery , Humans , Neurosurgical Procedures , Rhinitis, Allergic/metabolism , TemperatureABSTRACT
A few approaches can be used to decompress traumatic facial nerve paralysis including the middle cranial fossa approach or transmastoid approach depending on the site of injury. In some specific situation of treating traumatic facial nerve palsy whose injured site was confined from the geniculate ganglion to the second genu, transcanal endoscopic approach for facial nerve decompression can be used. We performed two cases of total endoscopic transcanal facial nerve decompression in patients with traumatic facial nerve palsy. After a six month follow-up, both patients showed improvement in facial function by 2 grades according to House-Brackmann grade system. In terms of treatment outcomes, total transcanal endoscopic facial nerve decompression for traumatic facial nerve palsy is an alternative for lesions limited to the tympanic segment I, and has an advantages of being minimally invasive and is cosmetically acceptable without an external scar or bony depression due to drilling.
Subject(s)
Decompression, Surgical/methods , Facial Nerve/surgery , Facial Paralysis/etiology , Geniculate Ganglion/diagnostic imaging , Neurosurgical Procedures/methods , Temporal Bone/injuries , Tomography, X-Ray Computed/methods , Adult , Endoscopy , Facial Nerve/diagnostic imaging , Facial Paralysis/diagnostic imaging , Facial Paralysis/surgery , Geniculate Ganglion/surgery , Humans , Male , Middle Aged , Temporal Bone/diagnostic imaging , Temporal Bone/surgery , Treatment OutcomeABSTRACT
OBJECTIVE: The aim of this paper would be to describe the first case series of exclusive transcanal endoscopic approach to treat lesions with limited extension at the suprageniculate fossa. This endoscopic approach allowed a complete removal of suprageniculate disesases with low complication rates using a minimally invasive surgical route. METHODS: This is a retrospective chart analysis and a surgery video recording review of these patients were performed in August 2015. From November 2011 to November 2015, 29 patients were submitted to an endoscopic transcanal lateral skull base surgery. From those 29 subjects, in 6 patients an exclusive endoscopic transcanal suprageniculate approach was performed to remove lesions located into the geniculate fossa. Surgical indications, pre-operative assessment, results were collected and the surgical technique were described. RESULTS: The final study group was composed of 6 patients. 3 male and 3 female; median age is 25.3 years old. In all 6 subjects it was possible to remove the lesions using an exclusive endoscopic transcanal suprageniculate approach. No intraoperaoperative complications were observed in any patients. The mean follow up period was 15.16 months. CONCLUSION: Exclusive endoscopic transcanal suprageniculate approach is definitely a minimally invasive technique and should be consider an optimal solution to treat lesions located in the suprageniculate fossa in some patients. We introduce a minimally invasive approach to the geniculate ganglion region in order to allow complete removal of suprageniculate disesases with low complication rates using a minimally invasive surgical route.