![]() ![]() Although the role of surgical decompression remains unclear, it appears that patients presenting with vertigo have more favorable response to surgical decompression as compared with those presenting with tinnitus and sensorineural hearing loss. Results Of the 13 patients who underwent surgical decompression, 8 patients had resolution of vertigo symptoms, 10 patients had improvement of tinnitus symptoms, and all patients maintained some level of serviceable hearing.Ĭonclusion IAC exostoses and osteomas are rare lesions that lead to insidious onset of debilitating symptoms from vestibulocochlear nerve dysfunction. A total of 26 reported cases were identified, and patient presenting symptoms, management strategies, and response to surgery was obtained when available. The ELS is identified as a thickening of dura mater posterior to the PSC and is sub sequently widely decompressed without inadvertent durotomy. Methods A comprehensive search was conducted using PubMed Central, Web of Science Core Collection, and Google Scholar databases to identify previous reports of IAC exostoses and osteomas. The surgical steps of ELS decompression comprise a wide canal wall-up mastoidectomy with decompression of the sigmoid sinus and the presigmoid dura, often referred to as the Trautman triangle. This middle cranial fossae exposure is used to expose I.A.C. We present two cases of IAC exostoses managed with surgical decompression and review the clinical outcomes of previously reported cases in the literature. Internal auditory canal (I.A.C.) porous to tympanic segment. The decision should be based on the functional status of the cranial nerves, for which reliable electrophysiological monitoring is indispensable.Background Exostoses and osteomas are benign, insidious lesions of the bone involving the internal acoustic canal (IAC). In view of the nonneoplastic characteristic of these lesions, a more conservative approach is justified. Intraoperative surgical findings of tumor infiltration of the faciocochlear cranial nerve complex may support simple observation. Accurate preoperative diagnosis by radiological means is not possible, but careful evaluation of the different signal intensities on magnetic resonance imaging studies may indicate this rare pathological condition. ![]() ![]() Symptoms and signs of internal auditory canal hamartomas are congruent with other typical pathological lesions of the internal auditory canal and cerebellopontine angle. Therefore, a radical tumor removal was performed that sacrificed the cochlear but preserved the facial nerve. INTERNAL AUDITORY MEATUS, exploration by middle cranial fossa approach with cranial nerve decompression. In Patient 2, minimal tumor dissection resulted in complete loss of auditory brainstem response without reversibility. In Patient 1, after nerve decompression by subtotal tumor removal, preserved auditory brainstem responses and facial nerve electromyography indicated functional nerve preservation and facilitated the decision for partial resection. In view of the unclear intraoperative histology, surgical management was based on criteria of cranial nerve function. The lesions were exposed via a suboccipital transmeatal approach, and tumor infiltration of the cochlear and/or facial cranial nerves was identified. Preoperative and Postoperative diagnosis: Foreign object in right ear. Code the following CPT code: Case Study 2. There were no complications noted, and the patient was sent to the recovery room in satisfactory condition. Two patients presented with clinical findings typical of vestibular schwannomas, i.e., tinnitus, hearing loss of 30 dB, and an intrameatal contrast-enhancing lesion on magnetic resonance imaging studies. LESSONS To the authors’ knowledge, this is the first report to describe decompression of the internal auditory canal via a retrosigmoid approach for symptomatic facial and cochlear nerve. A tympanostomy tube was placed in the left ear. To highlight the clinical, radiological, and surgical findings and therapeutic options for this rare entity, which may mimic a purely intrameatal vestibular schwannoma, and to define the particular aspects of preoperative differential diagnosis and surgical management. ![]()
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