In Vivo Application and Short-Term Outcomes of Exoscope-Assisted Near-Total Temporal Bone Resection for Malignancy

Introduction: Operative management of malignant petrous temporal bone tumors is challenging due to their deep location and complex regional anatomy. Resection with negative margins is the goal for oncological control. The purpose of this study was to evaluate the short-term outcomes following exoscope-assisted near-total temporal bone resection.

Methods: Patients with petrous temporal bone malignancies underwent a 3D exoscope-assisted en bloc near-total temporal bone resection including the petrous apex and its contents except for the carotid artery. Patient demographics, tumor characteristics, and perioperative complications were noted.

Results: Eight patients with Pittsburgh's stage-IV temporal bone malignancy were included. Two patients had primary temporal bone tumors, and six were primary or recurrent tumors from adjacent sites. Average operative resection length was 6 hours and 11 minutes (range: 3:53–12:18). Four (50%) had known intraoperative residual tumor. All patients free flap reconstruction of the skull base defect. There were no intraoperative complications. Five patients had one or more perioperative complication (medical = 5, flap-related = 3, neurological = 2). Six patients had new intracranial radiographic findings, two of which were symptomatic strokes. Median modified Rankin's score at discharge was 2.5. Average long-term follow-up was 12 months (range: 0.6–29 months). One patient died within a month of surgery. One patient developed a nonoperative pseudomeningocele. At last follow-up, one patient's residual disease progressed and another patient's disease had a distal recurrence.

Conclusion: Exoscope-assisted visualization of deep subtemporal regions supports safe, efficient en bloc resection of advanced malignancy involving the temporal bone. The long-term oncological and functional outcomes will be determined at future follow-up.

Publication History

Article published online:
12 February 2021