Partial labyrinthectomy in skull base and cerebellopontine angle surgery

It is now recognized that portions of the vestibular labyrinth can be surgically manipulated without producing significant loss of hearing. Consequently, controlled occlusion or removal of portions of the inner ear have been utilized both to treat specific diseases of the ear as well as improve access to areas of the medial skull base. The common theme in all of these procedures is the preservation of a distinct membranous labyrinth that separates endolymphatic and perilymphatic compartments. This article discusses a novel approach incorporating the partial removal of the innerear combined with removal of the petrous apex, the partial labyrinthine petrous apicectomy (PLPA) in the treatment of medial skull base lesions. The surgical technique is outlined as is treatment outcome. The benefits of this new approach are assessed by morphometric analysis of three-dimensional CT images. The indications for the PLPA approach are discussed.