Exoscope-Assisted Middle Cranial Fossa Approach for Repair of Tegmental Defects: A Cadaveric and Clinical Study

Recent studies highlighted how exoscopes may be employed to approach the lateral skull base. The use of exoscope-assisted procedures to repair middle cranial fossa (MCF) defects has not been fully explored. The surgical microscope in the same circumstances has been associated with relevant limitatio...

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Bibliographic Details
Published in:World neurosurgery 2022-12, Vol.168, p.103-110
Main Authors: Porto, Edoardo, Revuelta-Barbero, J. Manuel, Soriano, Roberto M., Sun, Hanyao, Solares, C. Arturo, Mattox, Douglas E., Pradilla, Gustavo, Vivas, Esther, Garzon-Muvdi, Tomas
Format: Article
Language:English
Subjects:
Cadaver
Cerebrospinal fluid leak
Cranial Fossa, Middle - surgery
Dissection
Encephalocele - surgery
Exoscope
Humans
Middle cranial fossa approach
Middle cranial fossa defects
Skull Base
Tegmen tympani
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Summary:Recent studies highlighted how exoscopes may be employed to approach the lateral skull base. The use of exoscope-assisted procedures to repair middle cranial fossa (MCF) defects has not been fully explored. The surgical microscope in the same circumstances has been associated with relevant limitations, such as its physical obstruction, among others. The aim of this study was to present a proof of concept of exoscope-assisted surgery for MCF defects. A detailed step-by-step MCF approach was performed on 2 alcohol-preserved, latex-injected cadaveric specimens under exoscopic magnification. An illustrative clinical case of encephalocele secondary to a spontaneous tegmen tympani defect repaired via an exoscope-assisted MCF approach was presented. The most common sites of MCF defects, the tegmen tympani and the arcuate eminence, were successfully exposed under exoscopic magnification. Dissection was easily performed; no damage to the dura mater or to vascular or neural structures occurred. In the clinical case, the exoscope-assisted technique demonstrated adequate maneuverability and magnification quality. After localization, the encephalocele was resected, and the MCF defect was repaired. The surgeon's position was comfortable, and operative time was not prolonged. The exoscope allows adequate exposure of the MCF floor with identification and preservation of key anatomical structures. The exoscope represents a valuable alternative to the microscope in reconstruction of MCF defects, offering high-quality magnification and proven maneuverability.
ISSN:1878-8750
1878-8769
DOI:10.1016/j.wneu.2022.09.096