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Decompression of the tympanic and labyrinthine segments of the facial nerve by middle cranial fossa approach: an anatomic study

  • Clinical Article - Neurosurgical Anatomy
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Abstract

Background

Peripheral facial palsy is characterized by the permanent or temporary interruption of facial muscle function. The middle cranial fossa (MCF) approach has been used to decompress the facial nerve (FN) when hearing needs to be preserved. In this work, we describe a technique for decompressing the FN through the MCF approach, which allows the direct exposure of the labyrinthine and entire tympanic segment of the FN, with preservation of inner ear function.

Methods

Twenty cadavers heads were used in this study. The reference landmarks used were the middle meningeal artery, greater superficial petrosal nerve, arcuate eminence, inferior petrosal sinus and meatal plane following the petrous apex from its most anterior and medial portion.

Results

The tympanic segment of the FN presented, on average, a total length of 11 ± 0.67 mm to the right and 11.5 ± 0.60 mm to the left. The longitudinal lengths of the bone window in the tegmen tympani were 16.8 ± 1.67 mm to the right and 16.8 ± 1.20 mm to the left. The cross-sectional lengths of the bone window in the tegmen tympani were 5.5 ± 1.20 mm and 5.0 ± 1.75 mm to the right and left sides, respectively. The average value of the elliptical area formed by the longitudinal and transversal lengths of the bone window made in the tegmen tympani was 72.5 ± 22.5 mm2 to the right and 65.9 ± 30.3 mm2 to the left.

Conclusion

The proposed technique can be used for the surgical decompression of the tympanic, labyrinthine and meatal segments of the FN through the MCF in addition to reducing the surgical time and the risk to patients.

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Authors and Affiliations

  1. Department of Otolaryngology, Nova Esperança Medical School (FAMENE), Rua Gov. Antonio da Silva Mariz, 600\198, João Pessoa, Brazil, CEP 58046-518

    Marcos Alexandre da Franca Pereira

  2. Department of Otolaryngology, University of São Paulo School of Medicine, São Paulo, Brazil

    Marcos Alexandre da Franca Pereira, Aline Gomes Bittencourt, Ricardo Ferreira Bento & Rubens de Brito

  3. Division of Functional Neurosurgery, Department of Neurology, University of São Paulo School of Medicine, São Paulo, Brazil

    Emerson Magno de Andrade

Authors
  1. Marcos Alexandre da Franca Pereira
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  2. Aline Gomes Bittencourt
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  3. Emerson Magno de Andrade
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  4. Ricardo Ferreira Bento
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  5. Rubens de Brito
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Correspondence to Marcos Alexandre da Franca Pereira.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards

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da Franca Pereira, M.A., Bittencourt, A.G., de Andrade, E.M. et al. Decompression of the tympanic and labyrinthine segments of the facial nerve by middle cranial fossa approach: an anatomic study. Acta Neurochir 158, 1205–1211 (2016). https://doi.org/10.1007/s00701-016-2796-2

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  • DOI: https://doi.org/10.1007/s00701-016-2796-2

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