Korean J Otorhinolaryngol-Head Neck Surg.  2017 Nov;60(11):548-553. 10.3342/kjorl-hns.2017.00262.

Hearing Preservation with the Transcrusal Approach to the Skull Base Lesion Combined with Other Transcranial Approach: Results of Consecutive Series of 5 Cases

• Lee SM
• Ko BJ
• Sung HK
• Kim HK
• Hong JB
• An YS

• KMID: 2396860
• DOI: http://doi.org/10.3342/kjorl-hns.2017.00262

Abstract

BACKGROUND AND OBJECTIVES
This study reviewed our experience and outcomes of surgery via transcrusal approach to the skull base lesions.
SUBJECTS AND METHOD
We performed transcrusal approach technique on five patients with skull base lesions (Cavernous malformation, Petroclival meningioma, Craniopharyngioma, Anaplastic astrocytoma, and Trigerminal epidermoid cyst) aiming at preserving hearing. Pre-and post-operative pure tone audiometry (PTA) and caloric test were performed in all patients. The transcrusal approach technique was performed as reported in the previous references. The approach included trephination of the superior and posterior semicircular canals from the ampullae to the common crus. The main outcome of this study was preserving hearing and the vestibular function after surgery, which was determined by PTA and caloric test.
RESULTS
The average diameter of skull base lesion of the five patients was 3.68 cm. The mean follow up period was 114.2 days. The pre-operative mean PTA of five patients was 11 dB. The mean PTA of five patients within seven days after surgery was 28 dB. The last measured mean PTA was 29.8 dB. The pre and post-operative caloric results measured revealed vestibular function deficit in all of the patients after surgery (mean decreased value: 64%). All patients were stable during the surgery. Complications included two cerebrospinal fluid leak (40%) and one cranial VI nerve deficit (20%).
CONCLUSION
Transcrusal approach is a method that can simultaneously preserve hearing and afford enough exposure of the skull base lesion if appropriately combined with other transcranial approach. We performed transcrusal approach targeting skull base lesion with hearing preservation, and we found excellent hearing result with this technique.

Keyword

Hearing preservation; Partial labyrinthectomy; Transcrusal approach

MeSH Terms

Astrocytoma
Audiometry
Caloric Tests
Cerebrospinal Fluid Leak
Craniopharyngioma
Follow-Up Studies
Hearing*
Humans
Meningioma
Methods
Semicircular Canals
Skull Base*
Skull*
Trephining