Allen B. Kantrowitz

Pigmented villonodular synovitis of the temporomandibular joint: Case report and review of the literature

A case of pigmented villonodular synovitis of the right temporomandibular joint with extension through the base of the skull into the middle cranial fossa is described. The patient initially had right-sided hearing loss. Physical examination revealed a mass in the right ear canal. Computerized axial tomography demonstrated a destructive lesion of the right temporomandibular joint, with extension into the middle cranial fossa. The surgical approach is discussed, and the 11 previously reported cases are reviewed.

Transoral-transclival clipping of a giant lower basilar artery aneurysm

The authors discuss the choice of the transoral-transclival approach for the repair of a lower basilar artery aneurysm in a 32-year-old sickle-cell patient. Efficiency of approach and minimization of damage to vital structures support the use of this technique. The risks of cerebrospinal fluid fistula and meningitis are considered. One year after operation, the patient is neurologically intact.

Transcallosal, transventricular approach to a basilar apex aneurysm.

A new approach to the basilar apex in a patient with a megadolichobasilar anomaly and an abnormally rostral basilar apex aneurysm is described. The details of the surgical approach and the advantages and limitations of this transcallosal, interseptal approach are described.

Use of neurosurgical techniques for removal of a cardiac tumor.

A 6-week-old male infant with a capillary hemangioma of the right atrioventricular groove adjacent to the right coronary artery and conduction system underwent successful resection with the aid of microneurosurgical instrumentation. The technical challenge was thought to be analogous to that encountered by microneurosurgeons in their dissection of brain tumors.

Transcranial translabyrinthine approach to vestibular schwannomas.

Surgeons who utilize the suboccipital approach for the removal of large vestibular schwannomas, can perform a planned labyrinthectomy from within the intracranial cavity via the suboccipital exposure. This transcranial translabyrinthine approach provides one of the major advantages of the conventional transmastoid translabyrinthine approach, namely, unambiguous identification of the facial nerve as it exits the internal auditory canal, without the need for complete mastoidectomy and labyrinthectomy. The labyrinthectomy is best performed prior to the complete exposure of the internal auditory canal. The approach requires the surgeon to identify the endolymphatic sac intracranially, then drill the temporal bone and follow the vestibular aqueduct to the utricle. The lateral and superior semicircular canal ampullae, the superior vestibular nerve, Bills bar, and the facial nerve at the lateral end of the internal auditory canal can then be identified. After testing on multiple cadaver temporal bones, this approach was used in patients with large tumours that extended far laterally in the internal auditory canal. The steps in the technique are described in detail.

Periaqueductal approach to cholesterol granulomas of the petrous apex.

The periaqueductal approach for the drainage of cholesterol granulomas of the petrons apex is described. As with previously reported approaches, the periaqueductal approach takes advantage of the high pneumatization of the temporal bone in this disease. It requires dissection of the supralabyrinthine air cell tract as well as air cells medial to the posterior semicircular canal. This requires a circumferential bony dissection, skeletonization, and preservation of the vestibular aqueduct and the identification of the internal auditory canal. This periaqueductal approach preserves hearing and provides an alternative to the infralabyrinthine and infracochlear approaches when their use is precluded by variations in the temporal bone.