CC BY-NC-ND 4.0 · Laryngorhinootologie 2019; 98(S 02): S147-S148
DOI: 10.1055/s-0039-1686472
Abstracts
Otology

The infracochlear appraoch for diagnostic or therapeutic petrous apicotomy

S Plontke
1   Universitäts-HNO-Klinik, Halle/S.
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    Introduction:

    Petrous apicotomy can be used therapeutically for drainage of cholesterol granuloma, mucocele, symptomatic effusion or purulent infection, and diagnostically to gain access for biopsies of tumorous lesion. Larger access to the petrous apex can be gained through a transtemporal/middle fossa or a retrosigmoid approach e.g. for surgically treating petrous apex lesions (petrous apicectomy). There are two main routes for the lesser invasive petrous apicotomy: the infracochlear and the infralabyrinthine route.

    Method:

    This video illustrates the infracochlear approach to the petrous apex in case of a diagnostic indication in a patient with an incidental, asymptomatic tumorous lesion of the right petrous apex with bony erosion.

    Results:

    After the bone of the floor of the ear canal and the hypotympanon were removed, the carotid artery and the jugular bulb were identified using a diamond burr. The route to the petrous apex is triangled by the cochlea superiorly, the jugular bulb posteriorly, and the carotid artery, anteriorly. After reaching the petrous apex lesion, biopsies were taken. The defect in the floor of the ear canal and the hypotympanon were reconstructed with cartilage and temporalis fascia. The patient recovered quickly from surgery without vertigo or hearing loss. Histological evaluation showed a chondrosarcoma. The patient opted for primary radiation therapy (C12, 63 Gy).

    Conclusions:

    The infracochlear approach is minimally invasive and can offer access to the petrous apex with minimal morbidity. The pathway, however, is narrow and deep and bounded by the jugular bulb and the carotid artery. The available space can be estimated from preoperative CT scans and if possible 3D reconstructions (as shown in the video). Navigation can additionally enhance safety.


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    Prof. Dr. med. Stefan Plontke
    Universitäts-HNO-Klinik,
    Ernst-Grube-Str. 40, 06120
    Halle/S.

    Publication History

    Publication Date:
    23 April 2019 (online)

    © 2019. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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