Objectives
To develop a novel grading system and appropriate surgical approaches for patients with diffuse type tensosynovial giant cell tumor (D‐TGCT) of the temporal bone.
Study Design
...Retrospective cohort study.
Methods
We retrospectively reviewed 31 patients with temporal bone D‐TGCT between June 2012 and July 2021. All patients underwent comprehensive clinical evaluations, including clinical presentations, hearing threshold, imaging studies, surgical approaches, and prognosis. A grading system was developed based on the tumor location and adjacent neurovascular structures involvement according to imaging and intraoperative findings.
Results
In this study, grade II tumors were the most common (13/31), followed by grades I (7/31), III (7/31), and IV (4/31) tumors. Seven grade I patients received the subtemporal middle cranial fossa approach (SMCF) combined with the canal wall up mastoidectomy and tympanoplasty (CWUT). Nine grade II patients underwent SMCF combined with subtotal petrosectomy (SPTR), and four grade II patients underwent SMCF combined with CWUT. Seven grade III patients received SMCF combined with SPTR and dura mater reconstruction, and four grade IV patients underwent infratemporal fossa approach type B. Gross total resection was achieved in all patients, and the median follow‐up time was 30.1 months (range, 4–96 months). Three patients (one grade II, one grade III, and one grade IV) had recurrence during follow‐up, and the patient with grade III tumor had two recurrences.
Conclusions
Gross total resection is the first‐line treatment for patients with D‐TGCT of the temporal bone. This novel grading system enables surgeons to select optimal surgical strategy. Long‐term follow‐up is mandatory postoperatively.
Level of Evidence
4 Laryngoscope, 132:1275–1284, 2022
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Audiometric outcomes following cochlear implantation (CI) in patients with temporal bone fracture (TBF) are variable and the pathophysiology is not well understood. Herein, we describe otopathologic ...findings in two such cases to provide insight into pathophysiology and outcomes.
Two patients had a history of head trauma resulting in bilateral TBF and sudden, profound, sensorineural hearing loss.
Both cases underwent unilateral CI following head trauma.
Both TBs from each patient were harvested postmortem and histologically analyzed to determine fracture lines, intralabyrinthine fibroosseous changes, and spiral ganglion neuron (SGN) counts. Clinical histories and audiometric outcomes were also reviewed.
In both cases, the implanted TB showed extensive intracochlear ossification, which was greater when fracture involved the cochlea. In contrast, the nonimplanted cochleae were patent with small osseous deposits at the round window membrane. Interaural SGN counts were lower on the implanted side and hearing results were moderate to poor.
Otopathologic analyses of patients with a CI after bilateral TBF are rare. Based on otopathology of two patients with bilateral TBF and subsequent CI, implanted TBs show extensive intracochlear fibroosseous changes greater than the nonimplanted side. Findings have implications for auditory rehabilitation after TBF.
Objectives:
To evaluate audiologic consequences of gunshot wounds (GSWs) to the temporal bone (TB), and to correlate hearing outcomes with neurologic and vascular injuries adjacent to the temporal ...bone.
Study design:
Retrospective case series.
Setting:
University-based level-one trauma center.
Methods:
Retrospective review of 35 patients surviving TB ballistic injury, 2012 to 2021. Main outcomes were audiologic results. Demographics, concomitant injuries, CT, and interventions were reviewed.
Results:
Mean age was 30.7 years; 80% male. Seventeen patients (48.6%) underwent audiologic testing. Mean pure tone average (PTA) was 75 ± 35 dB, bone line average 41 ± 26 dB, and speech discrimination score (SDS) 60 ± 43%. Nineteen (54.3%) demonstrated facial nerve injury (FNI), who were more likely to show SNHL especially anacusis, though their mean PTA and SDS were not statistically different from those without (P = .30 and .47, respectively). Radiographic review of those with sensorineural loss (SNHL, 6/17) revealed otic capsule-disrupting fracture (n = 2), pneumolabyrinth (n = 2), intracranial hemorrhage (n = 3). Those with mixed loss (6/17) showed otic capsule-sparing fracture (n = 6), EAC injury (n = 5), ossicular discontinuity (n = 2), and intracranial hemorrhage (n = 4). Two with mastoid tip fractures alone had normal audiograms. Audiometric outcomes were not predicted by concomitant CSF leak, spinal injuries, vascular injuries, cranial neuropathies, or traumatic brain injury.
Conclusions:
All patterns of hearing loss—conductive, sensorineural, mixed and normal—may be seen following TB ballistic injuries. Trauma severe enough to disrupt the facial nerve is more likely to cause anacusis. However, all should be formally evaluated, since ballistic injuries complicated by neurologic or vascular damage do not necessarily correlate with worse audiologic outcomes, while patients with minimal fractures may demonstrate losses.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
Objectives/Hypothesis
To describe the histopathology of the invasion patterns of advanced‐stage external auditory canal (EAC) squamous cell carcinoma (SCC).
Study Design
Retrospective cohort study.
...Methods
Retrospective analysis of medical records of patients diagnosed with EAC SCC available at the Massachusetts Eye and Ear temporal bone (TB) collection. TBs underwent processing for histologic examination. Hematoxylin and eosin–stained slides were examined. Histologic findings were compared to premortem clinical data.
Results
Nine TBs were identified. Male:female ratio was 6:3. The average age of diagnosis and duration of survival was 64 (46–80 years) and 2.3 years (1–50 months), respectively. All presented with T4 disease, most commonly due to petrous apex (PA) invasion and facial nerve (FN) weakness. The mastoid air cells system served as a tumor conduit to the tegmen mastoideum and overlying dura in four patients, posterior fossa dura in one patient, vertical segment of FN in four patients, and middle ear (ME) and lateral semicircular canal in five patients. The tumor did not penetrate the tympanic membrane, oval window membrane (fenestra vestibule), or round window (RW) membrane. Supra‐ and infralabyrinthine pneumatization patterns allowed direct routes to the PA. Translabyrinthine PA invasion was seen in two patients. The most common locus of otic capsule invasion was the cochlea. One patient had FN paralysis due to compression rather than invasion.
Conclusions
SCC does not tend to extend from the ME to the inner ear through the RW and vestibule‐stapedial ligament. Tumors tend to spread along the preexisting TB air‐tract routes. Well‐aerated TB, may facilitate extension to the PA.
Level of Evidence
4 Laryngoscope, 131:E590–E597, 2021
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Objectives/Hypothesis:
This study aims to determine whether there are improved performances in cadaver temporal bone dissection after training using a VR simulator as a teaching aid compared with ...traditional training methods
Study design:
Randomized control trial.
Methods:
Twenty participants with minimal temporal bone experience were recruited for this randomized control trial. After receiving the same didactic teaching they were randomized into two groups. The traditional group were to receive addition teaching via traditional teaching methods such as small group tutorials, videos, and models. The VR group received supervised teaching on the VR simulator. At the end of their teaching they were asked to perform a cadaveric temporal bone dissection and had their performance videoed and assessed by blinded assessors. The assessors judged the videos on four domains of assessments looking at the end product, injury size, overall performance, and technique. These assessments were based on the Welling's scale and OSATS.
Results:
The VR group performed significantly better in the end product of the dissection (VR 80% vs. traditional 45%, P‐value <.001) and caused smaller injuries to anatomic structures (VR 19% vs. traditional 36%, P‐value = .01). They also did better in the overall performance score (VR 55% vs. traditional 35%, P‐value = .04) There were no differences in the technique score. There was a fair to moderate degree of interrater reliability between the assessors (kappa = 0.33–0.47; Intraclass correlation coefficient = 0.34–0.76).
Conclusion:
Supervised teaching using a VR simulator seems to improve cadaveric temporal bone dissection performance compared with traditional teaching methods. Laryngoscope, 2011
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Demonstrate the utility of 3D printed temporal bone models in individual patient preoperative planning and simulation.
3D models of the temporal bone were made from 5 pediatric and adult patients at ...a tertiary academic hospital with challenging surgical anatomy planned for cochlear implantation or exteriorization of cholesteatoma with complex labyrinthine fistula. The 3D models were created from CT scan used for preoperative planning, simulation and intraoperative reference. The utility of models was assessed for ease of segmentation and production and impact on surgery in regard to reducing intraoperative time and costs, improving safety and efficacy.
Three patients received cochlear implants, two exteriorization of advanced cholesteatoma with fistulas (1 internal auditory canal/cochlea, 1 all three semicircular canals). Surgical planning and intraoperative referencing to the simulations by the attending surgeon and trainees significantly altered original surgical plans. In a case of X-linked hereditary deafness, optimal angles and rotation maneuvers for cochlear implant insertion reduced operating time by 93 min compared to the previous contralateral side surgery. Two cochlear implant cases planned for subtotal petrosectomy approach due to aberrant anatomy were successfully approached through routine mastoidectomy. The cholesteatoma cases were successfully exteriorized without necessitating partial labyrinthectomy or labyrinthine injury. There were no complications.
3D printed models for simulation training, surgical planning and use intraoperatively in temporal bone surgery demonstrated significant benefits in designing approaches, development of patient-specific techniques, avoidance of potential or actual complications encountered in previous or current surgery, and reduced surgical time and costs.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
It is still far away from most of us in that it requires complex 3D modeling.
To investigate a more precision, simple, convenient and economical three-dimensional (3D) printed temporal bone model ...printed by a commercial desktop 3D printer, which can be widely promoted and applied in the training of beginners in otology.
The CT data of the temporal bone were imported into Mimics to construct a 3D digital model of the temporal bone. After loaded into a high-precision 3D printer, a high-precision temporal bone model was printed at a scale of 1:1. Then, the model was evaluated by 5 senior attending physicians, including its morphological accuracy, simulation about surgery, advantages and educational value, using the 7-point Likert scale.
A life-like temporal bone model was successfully printed out. Five senior attending physicians all thought that the printed model was similar to the natural temporal bone in physical properties and the haptic sensation of bone drilling, and was accurate, simple, convenient and effective. In addition, the model was considered to be of high application value in the teaching of temporal bone anatomy and surgery simulation, which had a material cost of only 3 dollars.
The high-precision 3D printed temporal bone model is highly similar to the natural temporal bone, and can be conveniently and effectively used in the training of simulating temporal bone surgery for beginners in otology. Its production is simple and economical, so it can be popularized on a large scale.
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DOBA, IJS, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Background The increasing prevalence of virtual reality simulation in temporal bone surgery warrants an investigation to assess training effectiveness. Objectives To determine if temporal bone ...simulator use improves mastoidectomy performance. Data Sources Ovid Medline, Embase, and PubMed databases were systematically searched per the PRISMA guidelines. Review Methods Inclusion criteria were peer-reviewed publications that utilized quantitative data of mastoidectomy performance following the use of a temporal bone simulator. The search was restricted to human studies published in English. Studies were excluded if they were in non-peer-reviewed format, were descriptive in nature, or failed to provide surgical performance outcomes. Meta-analysis calculations were then performed. Results A meta-analysis based on the random-effects model revealed an improvement in overall mastoidectomy performance following training on the temporal bone simulator. A standardized mean difference of 0.87 (95% CI, 0.38-1.35) was generated in the setting of a heterogeneous study population ( I
= 64.3%, P < .006). Conclusion In the context of a diverse population of virtual reality simulation temporal bone surgery studies, meta-analysis calculations demonstrate an improvement in trainee mastoidectomy performance with virtual simulation training.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Skull base malignancies arising from the parotid gland, skin, or external auditory canal (EAC) can potentially involve the temporal bone. Management of these invasive tumors represents a true ...challenge considering the critical neurovascular relationships. Exoscope-assisted temporal bone resection (TBR) plays a crucial role in addressing such malignancies. The extent of disease is evaluated using the Pittsburgh staging system, which then guides the boundaries of resection. Lateral TBR (LTBR) relies on removal of the EAC and lateral ossicles and is generally appropriate for stage T1 and T2 tumors. Total TBR (TTBR) is reserved for high-grade tumors involving the petrous apex. The video can be found here: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23135.
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