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

Technical note

Restricted access

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.



  • View in gallery

    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).

  • View in gallery

    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).

  • View in gallery

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

  • View in gallery

    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.


  • 1

    Andrews JCValavanis AFisch U: Management of the internal carotid artery in surgery of the skull base. Laryngoscope 99:122412291989

  • 2

    Curran AJGullane PJBance MLDonald PJTemporal bone resection. Donald PJ: Surgery of the Skull Base PhiladelphiaLippincott-Raven1998. 377408

  • 3

    George BLot GTran Ba Huy P: The juxtacondylar approach to the jugular foramen (without petrous bone drilling). Surg Neurol 44:2792841995

  • 4

    Jackson CGGlasscock ME IIIMcKennan KXKoopmann CF JrLevine SCHays JW: The surgical treatment of skull-base tumors with intracranial extension. Otolaryngol Head Neck Surg 96:1751851987

  • 5

    Kawahara NSasaki TNibu KSugasawa MIchimura KNakatsuka T: Dumbbell type jugular foramen meningioma extending both into the posterior cranial fossa and into the parapharyngeal space: report of 2 cases with vascular reconstruction. Acta Neurochir (Wien) 140:3233311998

  • 6

    Lewis JS: Temporal bone resection. Review of 100 cases. Arch Otolaryngol 101:23251975

  • 7

    Ma KHFagan PA: Osteoradionecrosis of the temporal bone: a surgical technique of treatment. Laryngoscope 98:5545561988

  • 8

    Shimizu SMiyazaki TSuzuki SYamada MUtsuki SOka H: Supratentorial craniotomy using a threadwire saw. Technical note. Neurol Med Chir (Tokyo) 48:1911942008

  • 9

    Tomio STakakura K: Twelve cases of jugular foramen neurinoma. Skull Base Surg 1:1521601991

  • 10

    Tomita KKawahara N: The threadwire saw: a new device for cutting bone. J Bone Joint Surg Am 78:191519171996

  • 11

    Tomita KKawahara NToribatake YHeller JG: Expansive midline T-saw laminoplasty (modified spinous process-splitting) for the management of cervical myelopathy. Spine 23:32371998




All Time Past Year Past 30 Days
Abstract Views 67 67 5
Full Text Views 92 92 1
PDF Downloads 63 63 2
EPUB Downloads 0 0 0


Google Scholar