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The Facial Nerve and its Non-Neoplastic Disorders
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Christopher Skilbeck, Susan Standring, Michael Gleeson
At the distal end of the labyrinthine segment, the geniculate ganglion forms part of a sharp ‘hairpin’ turn, the geniculum or first genu of the facial nerve, that marks the start of the tympanic segment. At the geniculum, the nerve is cradled by the superior semicircular canal posteriorly and the cochlea anteriorly and inferiorly (Figure 112.4). The nerve may be accompanied by the subarachnoid space as far as the geniculate ganglion.18
Combined transmastoid/middle fossa approach for a petrous bone cholesteatoma: A case report and literature review
Published in Acta Oto-Laryngologica Case Reports, 2021
Kiyotaka Miyazato, Yohei Hokama, Hideki Nagamine, Akira Ganaha, Mikio Suzuki, Shogo Ishiuchi
A literature review revealed 20 cases of combined transmastoid/middle fossa approach. Patients included both men (n = 11) and women (n = 9), ranging in age from 10 to 67 years, diagnosed with petrous bone cholesteatoma or cholesterol granuloma (Table 1). Some patients presented with hearing loss, but none of the patients had a postoperative onset or worsening of hearing loss. Cerebrospinal fluid leakage was confirmed in one patient. In the present case, we preserved the anterior semicircular canal with the transmastoid approach for the lesion in the geniculum of the facial nerve and the middle fossa approach for the lesion in the anterior semicircular canal and petrous region. Complications of brain compression or cerebrospinal fluid leakage have been reported [5]. To minimize compression of the brain parenchyma due to the middle fossa approach in this case, we established spinal drainage in advance, drained approximately 20–40 mL of cerebrospinal fluid preoperatively, and administered an osmotic diuretic to minimize damage. Although cerebrospinal fluid leakage occurred intraoperatively in this case, outflow from the internal auditory meatus was confirmed during the resection of the cholesteatoma; therefore, the area was treated with calcium phosphate bone cement (BIOPEX®, HOYA Technosurgical Co. JAPAN TOKYO) and fascia grafts. This is a useful surgical technique for resecting a tumor going beyond the inner ear into the petrosa with the aim of preserving hearing and the facial nerve.