By John S. Oghalai, Colin L. W. Driscoll
Long awaited, this positive surgical atlas covers all points of neuro-otology and lateral cranium base tactics in comprehensively intimately. The lavishly illustrated step by step advisor is written by way of American specialists to make sure continuity among themes. The textual content is extremely established with step by step rationalization of every surgery and information and strategies sections in addition to a PEARLS part in each one bankruptcy. greater than 2 hundred really good paintings illustrations describe each one surgery with approximately six hundred extra intraoperative photographs with CT and MRI photos to coach particular case examples. this provides a whole academic event for the cranium base health care provider in education and an intensive reference for the skilled surgeon.
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Extra resources for Atlas of Neurotologic and Lateral Skull Base Surgery
Nevertheless, bone in this region does need to be removed in order to visualize the deeper regions of the drilled-out cavity, and fear of damaging hearing or the facial nerve should not prevent one from obtaining enough exposure to adequately perform the procedure. Middle Fossa Approaches 9. After removal of the petrous bone deep to the superior petrosal sinus (SPS), the posterior fossa dura is visible (asterisks), and the internal auditory canal has been skeletonized. Note the >180° exposure of the internal auditory canal.
IAC 23. The dura of the internal auditory canal is now visible after removing the overlying bone. Note that cerebrospinal fluid has been released, likely from a small tear in the posterior fossa dura. Approach to the Internal Auditory Canal 31 24. Blood vessels in the posterior fossa dura have been cauterized using the bipolar to prevent bleeding when opening it. Note the superior petrosal sinus (SPS) is under the tip of the retractor. The posterior fossa dura (PF) and middle fossa dura (MF) are identified.
To start the procedure, an inferiorly based U-flap provides excellent exposure. The important point is to start the anterior limb down at the root of the zygoma. This is necessary to provide enough anterior–inferior exposure and provides the required line of sight to the internal auditory canal. An inadequate opening may seriously impair the ability to expose and remove the tumor. It is a critical step in the operation. This incision can be shortened if desired. It still needs to start at the root of the zygoma, but the posterior limb may be reduced in length as long as adequate retraction is possible.