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[Anatomical study of auditory brainstem implantation through retrosigmoid approach]
Chao Cai1, Yong-xin Li, Huan-jiu Xi
1Key Laboratory of Otolaryngology, Head & Neck Surgery, Ministry of Education, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
Objective:
To provide anatomic data for auditory brainstem implantation (ABI) through the retrosigmoid approach.
Methods:
Simulated operations were performed on 30 web adult head specimens and the structure around the foramen of luschka was observed. Both microscope and endoscope were employed.
Results:
(1)The bony window, the most adjacent but not overlapping with sigmoid sinus, was a circle with a radius of 20 mm. Its center was located behind midpoint of the line from parietal notch to mastoid apex with a distance of (26.42 +/- 1.29) mm. The distance between bony window and transverse sinus, mastoid apex, foramen of luschka, jugular foramen, posterior edge of internal auditory meatus and root entry zone of the IX cranial nerve were (22.45 +/- 1.41) mm, (35.51 +/- 1.65) mm, (43.86 +/- 2.20) mm, (16.56 +/- 1.64) mm, (15.01 +/- 0.63) mm and (46.27 +/- 1.70) mm respectively; (2) The foramen of luschka can be spotted by using microscope or endoscope, especially 30 degrees angled endoscope. By this way, we could obtain a more distinct visual field without over-retraction of cerebellum and achieve the goal of minimally invasive surgery. The distance between the foramen of luschka and internal acoustic porus was (15.01 +/- 0.53) mm; (3) The foramen of luschka lies in the triangle formed by flocculus and root entry zone of glossopharyngeal nerve and rostral margin of biventer lobule. Choroids plexus acts as a direct landmark. the length of lateral recess was (17.53 +/- 1.03) mm. The distance between acoustic tubercle and the foramen of luschka and the root of cochlea never was (16.52 +/- 1.67) mm and (13.77 +/- 1.66) mm respectively.
Conclusion:
Adjustment of the angle of skull bone window and clarification of cerebellopontine angle are the keys to positioning the foramen of luschka. The usage of 30 degrees angled endoscope can identify the angle are the keys to positioning the foramen of luschka. The usage of 30 degrees angled endoscope can identify the foramen of luschka more accurately and expose the operation area more clearly.
