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2 results

  • Chapter 14 - Combined Retrosigmoid and Limited Anterior Petrosectomy (“Reverse Petrosectomy”)

  • from Section II - Open Combined Approaches
  • Edited by Vijay Agarwal
  • Book:
    Integrated Management of Complex Intracranial Lesions
    Published online:
    05 October 2021
    Print publication:
    21 October 2021, pp 150-157

  • Summary

    Traditionally, lesions communicating between the middle fossa or supratentorial cisterns and the posterior fossa have been addressed by middle fossa approaches with the addition of a traditional anterior petrosectomy, or alternatively presigmoid approaches incorporating a posterior petrosectomy. Alternatively, when global access is needed a combined petrosal approach may be used. These approaches have advantages and disadvantages that those using them frequently are well acquainted with, and will be covered elsewhere in this book. However, a less utilized approach that takes full advantage of the familiarity and relative ease of a retrosigmoid operation is the addition of a suprameatal boney removal (we euphemistically call this the reverse petrosectomy) in select cases, which minimizes approach-related morbidity and dissection. Further, an endoscope can be used to augment visualization previously accomplished with boney removal necessitated by the straight line of sight inherent to the microscope. Here we describe this technique in detail, taking advantage of a component-based approach to the skull base.

  • Superior petrosal sinus causing superior canal dehiscence syndrome

  • S M D Schneiders, J W Rainsbury, E F Hensen, R M Irving
  • Journal:
    The Journal of Laryngology & Otology / Volume 131 / Issue 7 / July 2017
    Published online by Cambridge University Press:
    15 May 2017, pp. 593-597
    Print publication:
    July 2017
  • Objective:

    To determine signs and symptoms for superior canal dehiscence syndrome caused by the superior petrosal sinus.

    Methods:

    A review of the English-language literature on PubMed and Embase databases was conducted, in addition to a multi-centre case series report.

    Results:

    The most common symptoms of 17 patients with superior petrosal sinus related superior canal dehiscence syndrome were: hearing loss (53 per cent), aural fullness (47 per cent), pulsatile tinnitus (41 per cent) and pressure-induced vertigo (41 per cent). The diagnosis was made by demonstration of the characteristic bony groove of the superior petrosal sinus and the ‘cookie bite’ out of the superior semicircular canal on computed tomography imaging.

    Conclusion:

    Pulsatile tinnitus, hearing loss, aural fullness and pressure-induced vertigo are the most common symptoms in superior petrosal sinus related superior canal dehiscence syndrome. Compared to superior canal dehiscence syndrome caused by the more common apical location of the dehiscence, pulsatile tinnitus and exercise-induced vertigo are more frequent, while sound-induced vertigo and autophony are less frequent. There is, however, considerable overlap between the two subtypes. The distinction cannot as yet be made on clinical signs and symptoms alone, and requires careful analysis of computed tomography imaging.