Analysis of the Most Medial Osteotomy in En Bloc Subtotal Temporal Bone Resection: Anatomical Cadaveric Study and Surgical Considerations.

Abstract

En bloc subtotal temporal bone resection (STBR) is a surgical technique used for the removal of temporal bone malignancies. However, few reports detailing resection of the most medial bone in this procedure have been published, although it is the most technically challenging aspect of en bloc STBR. In this study, we focused on the anatomical details of resection of the most medial bone in en bloc STBR, and we discuss the surgical nuances involved. Dissections were performed on 10 formalin-fixed cadaveric specimens. Following the subtemporal-infratemporal fossa and retromastoid-paracondylar approaches, resection of the medial portion to complete en bloc STBR was examined. To achieve en bloc STBR, we had to safely remove the bone within a triangular area anterior to the jugular fossa, posterior to the posterior genu of the petrous segment of the internal carotid artery, and directly above the carotid ridge on the medial side of the styloid process base. The region to be resected had mean (range) dimensions of 16 (12-25) mm anteriorly, 17 (12-25) mm posteriorly, and 10 (8-12) mm medially, with a total area of 76 (47-146) mm². En bloc STBR is a complex and technically demanding procedure, with the medial bone being the most challenging component to resect. This study emphasizes the importance of understanding the anatomical features of the medial bone for en bloc resection. It aims to contribute to the refinement of surgical techniques for temporal bone resection.