The translabyrinthine approach was developed by William F. House, M.D.,[1] who began doing dissections in the laboratory with the aid of magnification and subsequently developed the first middle cranial fossa and then the translabyrinthine approach for the removal of acoustic neuroma.
This surgical approach is typically performed by a team of surgeons, including a neurotologist (an ear, nose, and throat surgeon specializing in skull base surgery) as well as a neurosurgeon.
In this approach, the semicircular canals and vestibule, including the utricle and the saccule of the inner ear are removed with a surgical drill, causing complete sensorineural hearing loss in the operated ear. The facial nerve, which innervates the muscles of the face, is preserved in a higher percentage of cases than with other approaches.
Prior to the translabyrinthine approach, in the early 1960s acoustic neuromas were treated utilizing a suboccipital approach without the aid of an operating microscope. With the introduction of the translabyrinthine approach, mortality rates decreased from 40% in the State of California to 1%.
Otorhinolaryngology ( oh-toh-RYE-noh-LAR-ən-GOL-ə-jee, abbreviated ORL and also known as otolaryngology, otolaryngology–head and neck surgery, or ear, nose, and throat, is a surgical subspecialty within medicine that deals with the surgical and medical management of conditions of the head and neck. Doctors who specialize in this area are called otorhinolaryngologists, otolaryngologists, head and neck surgeons, or ENT surgeons or physicians. Patients seek treatment from an otorhinolaryngologist for diseases of the ear, nose, throat, base of the skull, head, and neck. These commonly include functional diseases that affect the senses and activities of eating, drinking, speaking, breathing, swallowing, and hearing. In addition, ENT surgery encompasses the surgical management and reconstruction of cancers and benign tumors of the head and neck as well as plastic surgery of the face and neck.
The vestibulocochlear nerve, known as the eighth cranial nerve, transmits sound and equilibrium (balance) information from the inner ear to the brain. Through olivocochlear fibers, it also transmits motor and modulatory information from the superior olivary complex in the brainstem to the cochlea.
A vestibular schwannoma (VS), also called acoustic neuroma, is a benign tumor that develops on the vestibulocochlear nerve that passes from the inner ear to the brain. The tumor originates when Schwann cells that form the insulating myelin sheath on the nerve malfunction. Normally, Schwann cells function beneficially to protect the nerves which transmit balance and sound information to the brain. However, sometimes a mutation in the tumor suppressor gene, NF2, located on chromosome 22, results in abnormal production of the cell protein named Merlin, and Schwann cells multiply to form a tumor. The tumor originates mostly on the vestibular division of the nerve rather than the cochlear division, but hearing as well as balance will be affected as the tumor enlarges.
Otoplasty denotes the surgical and non-surgical procedures for correcting the deformities and defects of the pinna, and for reconstructing a defective, or deformed, or absent external ear, consequent to congenital conditions and trauma. The otoplastic surgeon corrects the defect or deformity by creating an external ear that is of natural proportions, contour, and appearance, usually achieved by the reshaping, the moving, and the augmenting of the cartilaginous support framework of the pinna. Moreover, the occurrence of congenital ear deformities occasionally overlaps with other medical conditions.
Microsurgery is a general term for surgery requiring an operating microscope. The most obvious developments have been procedures developed to allow anastomosis of successively smaller blood vessels and nerves which have allowed transfer of tissue from one part of the body to another and re-attachment of severed parts. Microsurgical techniques are utilized by several specialties today, such as: general surgery, ophthalmology, orthopedic surgery, gynecological surgery, otolaryngology, neurosurgery, oral and maxillofacial surgery, plastic surgery, podiatric surgery and pediatric surgery.
Unilateral hearing loss (UHL) is a type of hearing impairment where there is normal hearing in one ear and impaired hearing in the other ear.
Otology is a branch of medicine which studies normal and pathological anatomy and physiology of the ear as well as their diseases, diagnosis and treatment. Otologic surgery generally refers to surgery of the middle ear and mastoid related to chronic otitis media, such as tympanoplasty, or ear drum surgery, ossiculoplasty, or surgery of the hearing bones, and mastoidectomy. Otology also includes surgical treatment of conductive hearing loss, such as stapedectomy surgery for otosclerosis.
Intraoperative neurophysiological monitoring (IONM) or intraoperative neuromonitoring is the use of electrophysiological methods such as electroencephalography (EEG), electromyography (EMG), and evoked potentials to monitor the functional integrity of certain neural structures during surgery. The purpose of IONM is to reduce the risk to the patient of iatrogenic damage to the nervous system, and/or to provide functional guidance to the surgeon and anesthesiologist.
Neurofibromatosis type II is a genetic condition that may be inherited or may arise spontaneously. The main manifestation of the condition is the development of bilateral benign brain tumors in the nerve sheath of the cranial nerve VIII, which is the "auditory-vestibular nerve" that transmits sensory information from the inner ear to the brain. Besides, other benign brain and spinal tumors occur. Symptoms depend on the presence, localisation and growth of the tumor(s). Many people with this condition also experience vision problems. Neurofibromatosis type II is caused by mutations of the "Merlin" gene, which seems to influence the form and movement of cells. The principal treatments consist of neurosurgical removal of the tumors and surgical treatment of the eye lesions. Historically the underlying disorder has not had any therapy due to the cell function caused by the genetic mutation.
A neuroma is a growth or tumor of nerve tissue. Neuromas tend to be benign ; many nerve tumors, including those that are commonly malignant, are nowadays referred to by other terms.
House Ear Institute, now the House Institute Foundation (HIF) is a non-profit 501(c)(3) organization, based in Los Angeles, California, and dedicated to advancing hearing science through research, education, and global hearing health to improve quality of life.
The cerebellopontine angle (CPA) is located between the cerebellum and the pons. The cerebellopontine angle is the site of the cerebellopontine angle cistern one of the subarachnoid cisterns that contains cerebrospinal fluid, arachnoid tissue, cranial nerves, and associated vessels. The cerebellopontine angle is also the site of a set of neurological disorders known as the cerebellopontine angle syndrome.
Computer-assisted surgery (CAS) represents a surgical concept and set of methods, that use computer technology for surgical planning, and for guiding or performing surgical interventions. CAS is also known as computer-aided surgery, computer-assisted intervention, image-guided surgery, digital surgery and surgical navigation, but these are terms that are more or less synonymous with CAS. CAS has been a leading factor in the development of robotic surgery.
The cerebellopontine angle syndrome is a distinct neurological syndrome of deficits that can arise due to the closeness of the cerebellopontine angle to specific cranial nerves. Indications include unilateral hearing loss (85%), speech impediments, disequilibrium, tremors or other loss of motor control. The cerebellopontine angle cistern is a subarachnoid cistern formed by the cerebellopontine angle that lies between the cerebellum and the pons. It is filled with cerebrospinal fluid and is a common site for the growth of acoustic neuromas or schwannomas.
Jugular foramen syndrome, or Vernet's syndrome, is characterized by paresis of the glossopharyngeal, vagal, and accessory nerves.
Robert F. Spetzler is a neurosurgeon and the J.N. Harber Chairman Emeritus of Neurological Surgery and director emeritus of the Barrow Neurological Institute in Phoenix, Arizona. He retired as an active neurosurgeon in July 2017. He is also Professor of Surgery, Section of Neurosurgery, at the University of Arizona College of Medicine in Tucson, Arizona.
Albert Loren Rhoton Jr., was an American neurosurgeon and a professor specializing in microsurgical neuroanatomy. He developed and introduced a number of microsurgical techniques that improved the safety and effectiveness of neurosurgery, including the use of the surgical microscope in neurosurgery. He also designed many of the commonly used of microneurosurgical instruments, which bear his name. Such tools in use worldwide include the Rhoton Micro Dissectors designed for delicate work in the treatment of brain aneurysms and tumor resection.
Thomas Annandale, FRCS FRSE (1838–1907) was a Scottish surgeon who conducted the first repair of the meniscus and the first successful removal of an acoustic neuroma, and introduced the pre-peritoneal approach to inguinal hernia repair. He served as Regius Professor of Clinical Surgery at the University of Edinburgh. His collection of anatomical specimens was donated to the Surgeon's Hall in Edinburgh and is now known as the Thomas Annandale Collection.
Ectopic salivary gland tissue which is located in sites other than the normal location is variously described as aberrant, accessory, ectopic, heterotopic or salivary gland choristoma.
Facial nerve decompression is a type of nerve decompression surgery where abnormal compression on the facial nerve is relieved.
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