Author(s)
Ahad A. Qureshi1,2, Vivek V. Kanumuri1,2, Lorenz Epprecht1,2, Sullivan S. Smith1,2, Osama Tarabichi1,2, Elliott D. Kozin1,2, Daniel J. Lee1,2
Affiliation(s)
1 Harvard School Of Medicine, 2 Massachusetts Eye And Ear Infirmary
Abstract:
INTRODUCTION: Development of advanced endoscopic approaches has enabled minimally invasive access to the lateral skull base. Incorporation of endoscopes has however been limited in Auditory Brainstem Implant (ABI) surgery, especially in the pediatric population. Endoscope-assisted retrolabyrinthine (RL) approach to the cerebellopontine angle has been described to reduce morbidity in tumor surgery; a similar approach for pediatric ABI implantation may result in similarly improved outcomes. Herein, we performed a radiological analysis to determine the anteromedial-posterolateral dimensions of the RL surgical corridor in our pediatric ABI cohort. METHOD: Pediatric ABI candidates with CT imaging of their temporal bones were included in this study. Patients with vestibular malformations were excluded. We analyzed temporal bone CT scans of 8 pediatric patients using the Synapse imaging platform. The minimum horizontal distance between the posterior semicircular canal (PSC) and the sigmoid sinus (SS) was measured, as well as the distance between the lateral semicircular canal (LSC) and the SS to assess feasibility of a limited translabyrinthine approach involving the PSC. RESULTS: The mean distance between the PSC and SS was 4.98 ± 2.44mm; the mean distance between LSC and SS was 7.46 ± 2.67mm. Considering an endoscopic diameter of 2.7 mm, endoscopic access with preservation of the PSC was bilaterally possible on 7 of 8 patients and unilaterally possible on the remaining patient; access was possible on all patients with obliteration of the PSC. CONCLUSION: Endoscope-assisted RL approach to pediatric ABI surgery appears feasible based on radiographic analysis of our cohort of pediatric ABI candidates.