Infratemporal post-auricular approach to middle cranial fossa (internal auditory meatus, petrous apex, tentorium, cavernous sinus, parasellar area, infratemporal fossa) including mastoidectomy, resection of sigmoid sinus, with or without decompression and
CPT4 code
Name of the Procedure:
Infratemporal Post-Auricular Approach to Middle Cranial Fossa (also known as mastoidectomy with resection of the sigmoid sinus, including potential decompression).
Summary
The infratemporal post-auricular approach to the middle cranial fossa is a surgical method used to access deep regions of the skull base. This includes areas like the internal auditory meatus, petrous apex, tentorium, cavernous sinus, parasellar area, and infratemporal fossa. It often involves a mastoidectomy (removal of part of the mastoid bone) and may include resection (removal) of the sigmoid sinus, with or without decompression of surrounding structures.
Purpose
This procedure is performed to address various conditions affecting the base of the skull, including tumors, infections, and structural abnormalities. The goal is to safely remove or treat these issues while minimizing damage to critical areas of the brain, nerves, and blood vessels.
Indications
Indications for this procedure include:
- Tumors of the middle cranial fossa or surrounding regions
- Infections requiring surgical intervention
- Structural abnormalities such as congenital defects or traumatic injuries
- Conditions leading to compression of cranial nerves or critical blood vessels
Preparation
- Patients may need to fast for several hours prior to the procedure.
- Medication adjustments, such as stopping blood thinners, may be necessary.
- Pre-operative imaging studies like CT or MRI scans will be required to plan the surgery.
Procedure Description
- The patient is placed under general anesthesia.
- An incision is made behind the ear (post-auricular region).
- Mastoidectomy is performed, removing part of the mastoid bone to create access.
- The sigmoid sinus is identified and may be resected if necessary.
- The target area within the middle cranial fossa (such as the petrous apex or cavernous sinus) is carefully accessed.
- Any necessary decompression is performed to alleviate pressure on nerves or vessels.
- The surgical site is closed, and a sterile dressing is applied.
Duration
The procedure typically takes several hours, depending on the complexity and extent of the surgery.
Setting
This procedure is performed in a hospital operating room with advanced surgical equipment.
Personnel
- Neurosurgeon or skull base surgeon
- Otolaryngologist (ENT surgeon)
- Anesthesiologist
- Surgical nurses and technicians
Risks and Complications
- Infection
- Bleeding
- Damage to cranial nerves
- Cerebrospinal fluid leak
- Hearing loss
- Dizziness or balance issues
- Stroke
Benefits
- Effective removal or treatment of tumors and other conditions
- Relief of symptoms such as pain, hearing loss, or nerve compression
- Improved quality of life and function
Recovery
- Patients may need to stay in the hospital for several days.
- Pain management and antibiotics may be prescribed.
- Restricted activities for several weeks, including avoiding heavy lifting and strenuous exercise.
- Follow-up appointments to monitor healing and address any complications.
Alternatives
- Radiation therapy or chemotherapy for tumors
- Less invasive surgical approaches, if applicable
- Conservative management for non-severe conditions
Patient Experience
- During the procedure, the patient will be under general anesthesia and will not feel any pain.
- Post-surgery, patients may experience pain, swelling, and discomfort around the surgical site.
- Pain management and comfort measures will be provided, and symptoms will gradually improve as recovery progresses.