By Vittorio, M.D. Colletti, James E. Benecke

Modern microsurgical recommendations have unfolded a brand new horizon for the otoneurosurgeon. This quantity is a crucial contribu­ tion to the scholar who's studying those surgical techniques. Surgical otoneurology has now handed the infancy level, yet remains to be a teen. As extra otologists and neurosurgeons turn into expert during this kind of surgical procedure, new and higher ways will evolve. definitely there has to be far better administration of the carotid artery because it passes in the course of the temporal bone. greater suggestions to maintain the IX, X, and XI nerves within the jugular bulb sector will be built, and extra tender tactics for administration of lesions contained in the cochlea and vestibular labyrinth will be built. As our diagnostic thoughts have more desirable, fairly via imaging, surgical concepts to check the enhanced diagnostic recommendations will emerge. For destiny otoneurologists who're pre­ pared, many difficulties concerning the temporal bone which are now thought of untreatable might be effectively controlled for terribly 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 perspective. This anatomy could be taught by way of demonstrating surgeries. This atlas that's an instance of cooperation among the universities of l. a. and Verona will enable the reader to rehearse otoneurosurgical techniques within the laboratory, and, while the thoughts were mastered, practice a few of the ways within the remedy of internal ear and cranium base lesions. William F. apartment MD.

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Inferiorly, the inferior petrosal sinus forms the border. N. Hemostasis is secured with bipolar cautery prior to closure. The facial nerve is reflected anteriorly. Strips of abdominal fat are insinuated into the defect and the wound is closed in layers. It is usually not necessary to disturb the anatomy of the external auditory canal and tympanic membrane. For lesions anterior to the carotid, the external auditory canal is removed. This will be discussed in the section on infratemporal fossa surgery.

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.

With a diamond burr and copious irrigation, a trough is created on both sides of the facial nerve to access at least 180 degrees. A thin shell of bone should be left on the nerve for protection. E. With a dental excavator, the thin shell of bone is removed from the facial nerve. The nerve is carefully elevated from the fallopian canal, starting inferiorly. The nerve is particularly tenacious near the stapedius tendon. More force must be used to free the nerve here, taking care not to avulse it.

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