Total Temporal Bone Resection Research Articles

Exoscope-assisted temporal bone resection: operative videos of the lateral and total techniques.

Skull base malignancies arising from the parotid gland, skin, or external auditory canal (EAC) can potentially involve the temporal bone. Management of these invasive tumors represents a true challenge considering the critical neurovascular relationships. Exoscope-assisted temporal bone resection (TBR) plays a crucial role in addressing such malignancies. The extent of disease is evaluated using the Pittsburgh staging system, which then guides the boundaries of resection. Lateral TBR (LTBR) relies on removal of the EAC and lateral ossicles and is generally appropriate for stage T1 and T2 tumors. Total TBR (TTBR) is reserved for high-grade tumors involving the petrous apex. The video can be found here: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23135.

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

To delineate the steps of exoscopic en bloc carotid artery-sparing total temporal bone resection for malignancies involving the temporal bone in a cadaveric model. Dissections were performed on 3 right-sided (3 sides) formalin-fixed, latex-injected cadaveric specimens. An exoscopic en bloc carotid artery-sparing total temporal bone resection was performed on each cadaver. In the past 4 years, 8 patients have undergone exoscope-assisted internal carotid artery-sparing total temporal bone resection with the technique described in this report. As an example, we present a representative case of a patient in whom this technique was used. Exoscope-assisted en bloc total temporal bone resections were performed on 3 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, 3 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. A case illustration and operative video utilizing these techniques is presented. Exoscope-assisted en bloc carotid artery-sparing total temporal bone resection is a feasible technique for management of malignancies with temporal bone invasion.

Temporal bone resection for lateral skull-base malignancies.

Malignancies involving the temporal bone are increasingly common and require specialized multi-disciplinary care. Given this complex location, involvement of the lateral skull base and local neurovascular structures is common. In this review we discuss general principles for temporal bone resection, as well as alternative and complementary surgical approaches that should be considered in the management of patients with temporal bone cancer. A comprehensive review on literature pertaining to temporal bone resection was performed. The primary surgical strategy for malignancies of the temporal bone is temporal bone resection. This may be limited to the ear canal and tympanic membrane (lateral temporal bone resection) or may include the otic capsule and its contents (subtotal temporal bone resection), and/or the petrous apex (total temporal bone resection). Management of adjacent neurovascular structures including the facial nerve, the carotid artery, and the jugular bulb/sigmoid sinus should be considered during surgical planning. Finally, adjunctive procedures such as parotidectomy and neck dissection may be required based on tumor stage. Temporal bone resection is an important technique in the treatment of lateral skull-base malignancies. This strategy should be incorporated into a multi-disciplinary approach to cancer.

Squamous cell carcinoma of tympano-mastoid region: a series of six cases

<p class="abstract">The malignancies of tympanomastoid region are very rare entity. These tumours are more common in elderly persons in 6th and 7th decade. Males are more commonly affected than females. Chronically discharging ears are considered as risk factor which may be due to metaplasia in the middle ear mucosa following prolonged chronic infection. The most common symptoms are long standing blood tinged ear discharge, severe nocturnal pain, rapidly growing polypoidal or granulomatous mass in EAC or middle ear, peripheral facial palsy and painless ulceration over pinna or EAC. CT scan for bony erosion and MRI for soft tissue involvement and neural invasion are investigations of choice. Tissue biopsy is must for histopathological examination and confirmation of diagnosis. Surgery and chemo-radiotherapy are the mainstay of treatment. Surgery includes wide local excision, lateral temporal bone resection, subtotal temporal bone resection and total temporal bone resection.</p><p class="abstract"> </p>

Diagnostic dilemma in a case of temporal bone carcinoma in a young man

Malignancy of temporal bone is a rare entity with an incidence of <0.2% of all head-and-neck cancer with an average age of occurrence at 60 years. We present here a case of a 21-year-old boy with temporal bone cancer who presented with clinical features of complicated chronic suppurative otitis media, radiologically as chronic osteomyelitis creating a diagnostic dilemma as there was no predisposing factor for osteomyelitis. The diagnosis was confirmed by open biopsy which revealed squamous cell carcinoma. The best survival rate is obtained with total temporal bone resection and post-operative radiotherapy.

Temporalis Tendon Transposition for Dynamic Facial Reanimation following Radical Oncologic Resection

Objectives: Report a patient series in which a temporalis tendon transposition was performed for facial paralysis following radical oncologic resection. 1) Describe the modifications in technique of temporalis tendon transfer associated with concurrent cancer resection. 2) Evaluate the effect of complex defects and their reconstruction on facial reanimation outcomes. Methods: Retrospective review of 10 patients who underwent orthodromic temporalis tendon transposition for dynamic facial reanimation of their facial paralysis following radical cancer resection from January 2010 through February 2013. Data was collected for parotid malignancy, defect composition, reconstructive details, postoperative course, complications, and outcomes. Results: All patients underwent radical parotidectomy with facial nerve sacrifice and resection of adjacent soft and/or bony tissue for parotid malignancy. Complex defects included cutaneous loss necessitating concurrent flap reconstruction (n=5), partial or total temporal bone resection (n=6), and mandibulectomy (n=2). All patients underwent dynamic reanimation with temporalis tendon transposition through a nasolabial incision. Facial reanimation was performed at the same time as the resection in 6 cases and in a delayed setting in 4 cases. There was no difference in outcomes in these two patient groups. Due to tumor involvement, six resections included sacrifice of the internal maxillary artery without resultant compromise of the temporalis transfer. During the follow-up period, all patients had improved facial symmetry at rest and developed voluntary motion with post-procedure facial training therapy. Conclusions: Temporalis tendon transposition is a reliable, straightforward option for dynamic facial reanimation in the oncologic patient. Radical resection does not prohibit using this technique.

Predictors of Survival and Recurrence after Temporal Bone Resection for Cancer

Malignant tumors of the temporal bone and external auditory canal are uncommon, with annual incidence estimated at between 1 and 6 per million.1,2 Cancers of the external auditory canal/temporal bone comprise <0.2% of head and neck cancers.3 The rarity and anatomic complexity of these tumors hampered the development of an en bloc ablative operation until 1954, when Parsons and Lewis4 from Memorial Hospital in New York first described the technique of subtotal temporal bone resection. Conley and Novack5 refined this technique further in 1960 with the description of lateral temporal bone resection. Subsequent developments in imaging, microsurgery, reconstruction, and neuroanesthesia have all contributed to advancements in skull base surgery. As a result, oncologic temporal bone procedures, including lateral, subtotal, and total temporal bone resection, have become the standard of care for malignant disease involving the external auditory canal/temporal bone. Survival and recurrence outcomes in patients with cancer of the external auditory canal/temporal bone have been reported in several single-institution series. Most cohorts have been limited to squamous cell histology, and comprehensive outcomes analyses have been limited.2,6–24 Further complicating analysis, there is no recognized American Joint Committee on Cancer (AJCC) or Union Internationale Contre le Cancer (UICC) staging system for tumors of the external auditory canal/temporal bone, with multiple systems having been proposed.3,16,25,26 To date, the most widely used system is the University of Pittsburgh staging system, first described in 1990 by Arriaga and colleagues25 and modified in 2000 by Moody et al.3 Other than Pittsburgh stage and surgical margin status, no other factors have been consistently demonstrated to be associated with outcome, and multivariable analyses of factors affecting outcome have not been reported.7,16,20,21 Such a comprehensive analysis of patient and tumor characteristics that are predictive of survival outcomes would aid clinical decision making and risk stratification. The objective of this study was to identify factors predictive of survival and recurrence in a contemporary cohort of patients undergoing temporal bone resection for cancer involving the external auditory canal/temporal bone.

Skull Base Surgery of the Temporal Bone

Objectives: The aim of this study was to review major temporal bone cases performed by one surgeon, and to highlight pitfalls and progress in the surgical management of previously unresectable neoplasms. Design: Retrospective case series review. Setting: Tertiary referral center. Participants: Nine patients who underwent total en bloc temporal bone resection for malignancy of the ear and temporal bone. Main Outcome Measures: Histories, surgical techniques, postoperative complications and outcomes, and changes in the approach to total en bloc resection of the temporal bone were analyzed. Results: With combinations of extensive surgery, radiation therapy, and chemotherapy, some patients with aggressive skull base neoplasms once deemed unresectable survive and appear free of disease. Total en bloc temporal bone resection was developed over 25 years ago. Additional experience has led to significant modifications in the technique, some of which have not been published previously. Conclusion: The morbidity and mortality associated with malignancy of the temporal bone may justify extensive surgery. In the hands of an experienced skull base team, total temporal bone resection can be performed successfully. This approach offers hope for survival in some patients with malignancy of the temporal bone.

Long-term outcome following radical temporal bone resection for lateral skull base malignancies: a neurosurgical perspective

Primary temporal bone malignancy is a rare form of tumor for which the therapeutic strategy remains controversial. In this study, the authors reviewed their experience with radical temporal bone resection (TBR) of such lesions and analyzed the long-term results to provide treatment recommendations. Between 1994 and 2006, 17 patients (10 men and 7 women) underwent total or subtotal TBR for primary temporal bone malignancies. Tumors were graded according to the University of Pittsburgh system. The effects of surgical margins and tumor extensions on patient survival were analyzed using the Kaplan-Meier method. All tumors, except 1, were graded T4 (most advanced). Subtotal TBR was performed in 14 patients, and total TBR was performed in 3. The surgical margin was tumor negative in 10 patients and tumor positive in 7. For large tumors extending into the infratemporal fossa or encroaching on the jugular foramen, orbitozygomatic (3 patients) and posterior transjugular (4 patients) approaches were combined with the standard approach, and en bloc resection with a negative margin was achieved in all cases but 1. The follow-up time ranged from 0.3-11.6 years (mean 3.3 years). The 5-year recurrence-free and disease-specific survival rates were 67.5 and 60.1%, respectively. When a negative surgical margin was achieved, the survival rates improved to 100 and 89%, respectively. The neurosurgical skull base technique could improve the probability of en bloc resection with a tumor-free margin for extensive temporal bone malignancies, which would cure a subset of patients. The active participation of neurosurgeons would improve patient care in this field.

Temporal bone carcinoma

Squamous cell carcinoma is the most common malignancy of the external auditory canal, middle ear, and mastoid. Surgical resection is the cornerstone of treatment, with T1 lesions of the external auditory canal treated by lateral temporal bone resection and more advanced lesions treated by subtotal or total temporal bone resection. This article summarizes clinical manifestations, differential diagnosis, management, and differences in treatment philosophy.

Squamous Cell Carcinoma of the External Auditory Meatus (Canal)

A retrospective study of 35 patients with squamous cell carcinoma of the external auditory meatus treated at the Eye and Ear Hospital of the University of Pittsburgh was performed. The standard treatment was a temporal bone resection that corresponded to the extent of the lesion, followed by postoperative radiation therapy. The tumor extensions, symptoms, treatments, survival rates, and prognostic variables were reviewed. Overall, 12 of 35 patients survived. Lesions limited to the external auditory meatus with no erosion had excellent prognoses. Survival in intermediate lesions with bony erosion or middle ear involvement was related to the status of surgical margins after partial or subtotal temporal bone resections. Extensive lesions that involved the surrounding soft tissue or dura had poor prognoses. The survival value of total temporal bone resection remains unproved.

Total Temporal Bone Resection: A Radical But Life-Saving Procedure

Traditional therapeutic approaches for malignancies of the temporal bone have produced unacceptably low survival figures. The morbidity and mortality associated with temporal bone cancer justify extensive surgery. Total temporal bone resection can be performed successfully in the hands of an experienced skull-base surgical team. By circumscribing the tumor rather than transgressing it, this procedure follows generally accepted principles of oncologic surgery. This procedure also shows promise in resection of extensive, carefully selected, recurrent benign tumors. We believe this approach offers hope for improved survival in patients with malignancy of the temporal bone. Further refinements in technique are suggested by each new case. Additional experience and long-term follow-up are needed to assess the efficacy of this procedure. The interest, expertise, and active participation of the operating room nursing team are critical to the success of this surgery. Ideally, not only intraoperative participation but also preoperative assessment and postoperative support should be routine. Close cooperation and extensive communication among the surgeons and nurses are essential.

Interdisciplinary Management of Skull Base Neoplasms

Patrick J. Gullane, MD, and F. Gentilli, MD, University of Toronto, presented their experience with the interdisciplinary management of skull base tumors at the American Academy of Otolaryngology–Head Neck Surgery meeting held this September in Chicago. Their series consisted of 25 patients who ranged in age from 18 to 74 years. Seven of these patients had anteriorly located tumors, six were anterolateral, and 12 were posterolateral. Patients with anterior tumors were operated on via a standard craniofacial approach, with split cranium employed most frequently for reconstruction of the bony defect. Anterolateral tumors were approached by laterally extending a bicoronal flap. The zygoma was removed and the facial nerve reflected if indicated. The last group of patients often required radical neck dissection in addition to their primary excision. The most frequent disease in this group was carcinoma of the temporal bone, which necessitated total temporal bone resection. These patients usually underwent

Long-term observation of total temporal bone resection in carcinoma of the middle ear and temporal bone

Long-term observation of total temporal bone resection in carcinoma of the middle ear and temporal bone