Combined Endoscopic and Microscopic Surgery for Perilabyrinthine Lesions: Feasibility and Technique

By June 7, 2019

Feng, Guodong1; Wei, Xingmei1; Gao, Zhiqiang1; Tian, Xu1; Zhao, Yang1
1 Department of Otorhinolaryngology – Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.

This study aimed to verify the feasibility of endoscopic-assisted surgery for lesions involving the perilabyrinthine recesses and further to certify the technique can increase the possibility of labyrinth and cochlea preservation.

-Study Design: Observational studies
-Setting: Referral center.
-Patients: Eleven cadaveric heads (22 temporal bones) and five patients who underwent endoscopy-assisted surgery for lateral skull base pathology involving the perilabyrinthine recesses between July 2010 and March 2016 were reviewed.
-Interventions: High-resolution computed tomography was performed on temporal bones, images were reconstructed and measured with Mimics and 3-matic software. The perilabyrinthine area was subdivided into five regions. Eleven distances were measured in these recesses. Clinical data of the five patients were collected.

-Main Outcomes and Measures: Hearing level and recurrence.
-Results: The distances in perilabyrinthine recess were larger than the diameter of the endoscope (2.7 mm), except for two shortest distances. Among the five patients (three females, two males), three had petrous bone cholesteatoma, one had facial neurofibroma, and one had petrous bone cholesterol granuloma. Complete excision with labyrinth and cochlea preservation was achieved in all cases with the endoscopic-assisted technique. Four patients had preoperative conductive hearing loss and one was totally deaf. The postoperative air–bone gap in one case was 30 dB lower than preoperative levels, one stayed the same, and one was 30 dB higher due to closing of the external ear canal. After an average follow-up of 62.9 months, no patient had recurrence.
-Conclusions: Endoscope-assisted surgery is feasible for lesions involving the perilabyrinthine recesses and can increase the possibility of labyrinth/cochlea preservation.