By Vittorio, M.D. Colletti, James E. Benecke
Modern microsurgical ideas have unfolded a brand new horizon for the otoneurosurgeon. This quantity is a crucial contribu tion to the scholar who's studying those surgical methods. Surgical otoneurology has now handed the infancy degree, yet remains to be a teen. As extra otologists and neurosurgeons turn into expert during this kind of surgical procedure, new and higher techniques will evolve. definitely there should be far better administration of the carotid artery because it passes during the temporal bone. larger thoughts to maintain the IX, X, and XI nerves within the jugular bulb quarter could be constructed, and extra smooth strategies for administration of lesions contained in the cochlea and vestibular labyrinth can be constructed. As our diagnostic suggestions have stronger, fairly via imaging, surgical ideas to check the enhanced diagnostic thoughts will emerge. For destiny otoneurologists who're pre pared, many difficulties concerning the temporal bone which are now thought of untreatable may be effectively controlled for extraordinarily thankful sufferers. the aim of this article is to familiarize the otoneurosur geon with the anatomy of the temporal bone, cranium base, infratem poral fossa, and cerebellopontine attitude. This anatomy could be taught through demonstrating surgeries. This atlas that is an instance of cooperation among the colleges of l. a. and Verona will let the reader to rehearse otoneurosurgical tactics within the laboratory, and, whilst the innovations were mastered, observe a number of the methods within the remedy of internal ear and cranium base lesions. William F. apartment MD.
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Additional info for Colour Atlas of Micro-Oto-Neurosurgical Procedures
Opening the arachnoid between the inferior pole of the tumor and the jugular bulb usually results in brisk egress of CSF. C. Two structures must be kept in mind while opening the dura: the petrosal vein and the anterior inferior cerebellar artery (AICA). The petrosal vein is located superiorly and can bleed profusely if disrupted. AICA is usually located inferior to large tumors, but can be found almost anywhere in the CP angle. Heeding these two structures, and with adequate exposure of the tumor, one first biopsies the lesion for histologic confirmation.
The plane between the facial and tumor is developed. The tumor is gutted and its capsule removed piecemeal. I. Superiorly, bone removal follows the superior petrosal sinus to Meckel's cave. Inferiorly, bone removal identifies the inferior petrosal sinus at its junction with the jugular bulb. Medially, bone removal extends into the clivus. J. This dissection defines a triangle covered by dura. The apex is Meckel's cave. Superiorly the triangle is bounded by the superior petrosal sinus. Inferiorly, the inferior petrosal sinus forms the border.
The lAC can be blue-lined now for positive identification. One must proceed with bone removal around the IAe. A diamond burr is used to create a trough anteriorly and posteriorly to the lAC until 270 degrees of bone have been removed from around the lAC. As one nears the porus medially, one is afforded more room. Near the lateral end of the lAC, keep in mind the location of the superior canal in order to avoid inadvertent fenestration. M. For acoustic tumor removal, it is necessary to carry bone removal to the porus.