Abstract
Purpose
The objective of this study is to describe the detailed surgical anatomy of the infracochlear approach to prevent complications and to compare the postauricular transcanal microscopic and endoscopic approaches to reach the petrous apex.
Methods
Cadaver heads were dissected using a binocular surgical microscope, endoscopes, and an electric drill. The dimensions of the access field that could be reached and manipulated with surgical instruments and straight drill via postauricular transcanal microscopic and endoscopic approaches were evaluated.
Results
Both postauricular microscopic and transcanal endoscopic approaches were considered to be inapplicable in cases with a tympanic cavity located jugular bulb closer than 3 mm to the cochlea. This relationship was seen in 3 (9%) sides of the cadavers. In 4 specimens (12%), a cochlear aqueduct with an open lumen was detected. Both postauricular microscopic and transcanal endoscopic approaches reached a nearly identic dissection area. Detailed anatomy of the approach and measurements about the topography of the third portion of the facial nerve from the tympanic cavity were presented.
Conclusion
Both traditional microscopic postauricular and endoscopic transcanal approaches provided comparable access areas to the inferior petrous apex with wide exposure, and radiologic measurements were compatible. A tympanic cavity located jugular bulb in close relation with cochlea was the only instance that restricted the applicability of this technique.
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The authors thank all donors of the cadavers used in this study and to their families.
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All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Ela Cömert and Ayhan Cömert. The first draft of the manuscript was written by Ela Cömert and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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The study is as an anatomic cadaveric research. Ankara University Faculty of Medicine Institutional Review Board has confirmed that the study is an exemption and does not require approval.
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Cömert, E., Cömert, A. Surgical anatomy of the transcanal infracochlear approach. Eur Arch Otorhinolaryngol 279, 159–168 (2022). https://doi.org/10.1007/s00405-021-06635-6
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DOI: https://doi.org/10.1007/s00405-021-06635-6