A Surgical Approach and Institutional Experience with Partial Labyrinthectomy Petrous Apicectomy Surgery: A Technical Description and Summary of Institutional Experience of 66 Cases
Notice bibliographique
Résumé
Introduction: Partial labyrinthectomy petrous apicectomy (PLPA) is a transpetrous route for approaching clival pathology that is intended to preserve hearing while offering the advantages of labyrinthectomy. A single-surgeon team composed of a fellowship-trained skull base neurosurgeon, otolaryngologist, and neurophysiologist at a tertiary-care center have completed a total of 66 cases utilizing this approach. Methods: A description, diagrams, and intraoperative imaging of this surgical approach utilized at our center is provided. Four handed surgery is performed using a diploscope which has been shown to reduce operating time, blood loss, and improve resection rates in skull base surgery. A cosmetic superficial mastoidectomy is performed prior to drilling, allowing for replacement with titanium fixation. Removal of the lateral and superior semicircular canals is performed by the otolaryngology team in addition to exposure of the sigmoid sinus and petrous apicectomy offering a robust exposure that minimized required retraction throughout the procedure. Intraoperative neurophysiological monitoring is utilized in all cases but tailored to the requirements of the patient. Typically for pathology in this region EMGs/motor evoked potentials of the relevant cranial nerves, four limb SSEPs and MEPs, and brainstem auditory-evoked responses are utilized. Additionally, a chart review was completed on all PLPA cases performed by our surgical team for patient’s demographic, clinical, pathological, and radiographic information pre- and postoperatively. Results: A total of 66 cases, aged 16 to 74 years, were completed using a PLPA approach from 2002 to 2023 by our surgical team. The most common pathology approached with a PLPA exposure at our institution was petroclival meningioma totalling 44/66 (66.7%) of cases. Other pathology approached via PLPA at our institution include epidermoid tumors: 13/66 (19.7%), vestibular schwannoma: (3/66) 4.5%, trigeminal schwannoma: 2/66 (3%), and 1/66 (1.5%) each of facial nerve and solitary fibrous tumors. The average diameter of these lesions was 4.4 cm (range: 1.3–7.2 cm). A gross total resection was achieved in 25/66 (37.8%), near total, defined as >90% tumor resection was achieved in an additional 14/66 (21.2%). An attempt to preserve hearing was made in all patients with hearing at preoperative assessment totalling 44/65 patients. Of these patients, hearing was preserved in 31/44 (70.45%). There were 27/66 (40.1%) cranial nerve deficits. There were 2 of 66 (3%) CSF leaks that required readmission to hospital. One required operative repair. 27 of 66 (40.1%) patients had postoperative cranial nerve deficits. Four of 66 (6%) patients had new motor deficits postoperatively. Eleven of 66 (16.7%) had transient worsening of existing hemiparesis postoperatively. All cases improved. There was a single case of postoperative dysphasia (1.5%), attributed to temporal lobe retraction. There were zero mortality at 90 days postoperative. Conclusion: Use of a PLPA approach is safe and robust in properly selected patients with reasonable hearing preservation. Modifications to surgical technique can help improve the safety and efficacy of this approach. Publication History Article published online: 07 February 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,002 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».