Atticostomy- A New Approach to Epitympanic Tumors

Epitympanum is a rare site for tumor but can be involved by tumors of horizontal and labyrinthine part of facial nerve. This space is a complex and crowded area containing nerves & ossicles and has close proximity to vital sense organs like cochlea, and semicircular canals. Surgery in this area is challenging as removal of disease with minimal damage to surrounding structure is difficult. Surgical approach to this area involves either disruption of ear canal or via middle cranial fossa which are associated with avoidable morbidity. To overcome these drawbacks of current approaches to epitympanic tumor, a new approach- 'Atticostomy' is described.

This approach involves removal of epitympanic tumors through a window made in attic area without disrupting bony ear canal. After making a endaural incision, squmous part of temporal bone just superior to bony ear canal is exposed. Tympanomeatal flap is elevated. Atticostomy (a window in attic) is made to reach in epitympanum with preserving bony canal framework. Incus along with head of malleus can be removed if required. Tumors of epitympanum, horizontal and labyrinthine segment of facial nerve can be dissected through this atticostomy.

Advantages of this minimally invasive approach includes faster post operative recovery and preservation of normal anatomy & hearing. If Incus and Head of malleus are removed then ossiculoplasty can be done in the same or second sitting. A case of removal of Schwannoma of labyrinthine part of facial nerve with repaire of dehisence of supirior semicircular cannal will be presented.