By Vittorio, M.D. Colletti, James E. Benecke
Modern microsurgical strategies have spread out a brand new horizon for the otoneurosurgeon. This quantity is a vital contribu tion to the coed who's studying those surgical techniques. Surgical otoneurology has now handed the infancy level, yet remains to be a youngster. As extra otologists and neurosurgeons develop into expert during this kind of surgical procedure, new and higher techniques will evolve. definitely there has to be far better administration of the carotid artery because it passes during the temporal bone. higher recommendations to maintain the IX, X, and XI nerves within the jugular bulb zone may be built, and extra tender techniques for administration of lesions contained in the cochlea and vestibular labyrinth will be constructed. As our diagnostic strategies have stronger, quite via imaging, surgical recommendations to check the enhanced diagnostic concepts will emerge. For destiny otoneurologists who're pre pared, many difficulties regarding the temporal bone which are now thought of untreatable could 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 can be taught through demonstrating surgeries. This atlas that is an instance of cooperation among the colleges of l. a. and Verona will enable the reader to rehearse otoneurosurgical approaches within the laboratory, and, whilst the options were mastered, practice a few of the ways within the remedy of internal ear and cranium base lesions. William F. condo MD.
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Additional info for Colour Atlas of Micro-Oto-Neurosurgical Procedures
70 XI. INFRATEMPORAL FOSSA APPROACH The infratemporal fossa approach was designed to provide access to the skull base for resection of large glomus tumors and other lesions of the jugular foramen area. The facial nerve is rerouted anteriorly to provide direct access to the jugular foramen and adjacent skull base. This approach can allow the surgeon to control the intratemporal portion of the carotid artery and follow it to the parasellar area. Transcochlear extention of this approach provides access to the clivus and areas medial to the carotid.
F. The bone flap is removed with an Adson elevator and the dura at the edges of the craniotomy elevated from the overlying bone. G. The self-retaining House-Urban middle fossa retractor is inserted and locked onto the bone surrounding the defect. Dural dissection begins at the floor of the middle fossa and proceeds laterally to medially. If a bone ledge obscures vision of the middle fossa floor, it is removed with a rongeur. H. Begin dural elevation anteriorly, approaching the foramen spinosum.
Like the retrolabyrinth approach, it must be well posterior. The incision is carried down into the neck for a distance of roughly 3 cm below the mastoid tip. B. The dissection is identical as for the retrolabyrinthine approach, including the administration of mannitol and lasix. C. Once adequate retrolabyrinthine bone removal has been accomplished, a large rongeur is used to remove an additional 3-4 cm of bone from the subocciput behind the sigmoid. A large section of posterior fossa dura is hence exposed behind the sigmoid.