Exoscopic En Bloc Near-Total Temporal Bone Resection: Feasibility Study and Operative Technique

Introduction: Operative management of malignant temporal bone tumors is challenging due to the aggressive tumor pathology and complex regional anatomy. Resection with negative margins is the goal for oncological control prior to adjuvant therapies. En bloc techniques have been advocated specifically for resecting temporal bone malignancies. Use of extracorporal videoscopic visualization (i.e., exoscope) is a promising tool that may enhance intraoperative optics for these approaches.

Objective: This study was aimed to evaluate the feasibility and delineate the steps of exoscopic en bloc carotid artery-sparing total temporal bone resection for temporal bone malignancies in a cadaver model.

Results: Exoscope-assisted en bloc near-total temporal bone resections were performed on three right-sided cadaveric specimens. The following steps were described to circumferentially expose the petrous temporal bone: infratemporal fossa exposure, temporal craniotomy for subtemporal middle fossa approach to the petrous bone, retrosigmoid craniotomy, and transjugular approach. Finally, three skull base osteotomies were performed to liberate anterior, medial, posterior attachments of the petrous bone for en bloc removal. Possible extensions of these dissections as indicated by tumor pathology were described.

Conclusion: Exoscope-assisted en bloc carotid artery-sparing total temporal bone resection is a feasible technique for management of temporal bone malignancies.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
12 February 2021