Middle Fossa Approach to an Osteoma of the Internal Auditory Canal Facilitated by Augmented Reality: 2-Dimensional Operative Video

Petrous bone osteomas are benign bony lesions that are often asymptomatic and incidentally found.1 When present in this location, these lesions can compress the facial and vestibulocochlear nerves, leading to tinnitus, vertigo, sensorineural hearing loss, hemifacial spasm, or facial palsy.2,3 Most cases of osteomas do not require any treatment and are safe to observe However, in symptomatic patients in the setting of a large osteoma with severe compression of the vestibulocochlear or facial nerves, treatment can be considered to alleviate mass effect and prevent further neurological deterioration Here, we present the resection of a left-sided osteoma of the internal auditory canal (IAC) through a middle fossa approach in a 46-year-old woman who presented with symptoms of tinnitus, mild unilateral sensorineural hearing loss, and recurrent vertigo episodes We demonstrate the use of intraoperative augmented reality to project the osteoma and surrounding neurological structures intermittently through the microscope oculars The patient had an uneventful postoperative course with preservation of her facial nerve function, and at the 6-month follow-up, the patient reported resolution of her vertigo as well as improvement in her left-sided hearing Intraoperative image guidance with augmented reality is useful in the resection of complex IAC osteomas, particularly given that these tumors are bony and fixed to the petrous bone Drilling guides can be planned and projected onto the patient's anatomy to accurately target the optimal location to drill and ensure complete removal of the tumor The patient consented to the procedure and to the publication of her image The video and the Mayo Clinic logo within the video are used with permission of Mayo Foundation for Medical Education and Research, all rights reserved. © 2023 Oxford University Press. All rights reserved.