En bloc temporal bone resection using a diamond threadwire saw for malignant tumors

Technical note

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The purpose of this study is to describe a new technique for en bloc temporal bone resection using a diamond threadwire saw (T-saw) as an alternative to cutting the temporal bone with an osteotome. This technique has been performed in 10 patients with external auditory canal and middle ear cancers without any injury to the internal carotid artery or jugular vein. The authors conclude that the use of a diamond threadwire saw after transposing the internal carotid artery anteriorly is a safe, simple, and reliable technique for en bloc temporal bone resection.

Abbreviations used in this paper: IAC = internal auditory canal; ICA = internal carotid artery.

Article Information

Address correspondence to: Hiroyuki Jimbo, M.D., 1163 Tatemachi, Hachioji, Tokyo 193-0988, Japan. email: hjimbo@tokyomed.ac.jp.

Please include this information when citing this paper: published online August 27, 2010; DOI: 10.3171/2010.8.JNS10294.

© AANS, except where prohibited by US copyright law.

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Figures

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    Illustrations of the operative technique. Left: Schema of the final cuts in en bloc temporal bone resection using a diamond T-saw. Right: Illustration of en bloc temporal bone resection using the diamond T-saw. Nicks for the diamond T-saw (dashed line) represent the following: from the transition point of the C6/C7 segment of the ICA that continues to the cochlea and IAC to the tegmen mastoideum (upper and middle resection line); to just behind the C7 segment of the ICA, which is transposed anteriorly (anterior resection line); and from the tegmen mastoideum to the IAC and jugular foramen (posterior resection line).

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    Intraoperative photographs of the technique. Left: Image showing the C6 and C7 segments of the ICA and the third branch of the trigeminal nerve (V3). Right: Image showing the anterior resection line that is the just behind the C7 segment of the ICA, which is transposed anteriorly (dashed line).

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    Intraoperative photograph showing en bloc temporal bone resection using a diamond T-saw (arrows).

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    Preoperative (A and B) and postoperative (C) images obtained in a 54-year-old woman with a squamous cell carcinoma. Axial (A) and coronal (B) MR images show the carcinoma occupying the external ear canal. An axial CT scan (C) shows subtotal resection of temporal bone and a revascularized rectus muscle–fat free flap in the dead space.

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