By John S. Oghalai, Colin L. W. Driscoll
Long awaited, this fantastic surgical atlas covers all points of neuro-otology and lateral cranium base approaches in comprehensively intimately. The lavishly illustrated step by step consultant is written by way of American specialists to make sure continuity among subject matters. The textual content is very dependent with step by step clarification of every surgery and advice and methods sections in addition to a PEARLS part in each one bankruptcy. greater than 2 hundred amazing art illustrations describe each one surgery with approximately six hundred extra intraoperative photographs with CT and MRI pictures to coach particular case examples. this provides a whole academic event for the cranium base doctor 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
23 MMA GSPN FO AE SPS Dissecting medially and anteriorly will then permit identification of the GSPN as described. These two landmarks (the petrous ridge and the GSPN) should give you sufficient orientation to anticipate the location of all other structures. There is a tendency to not dissect far enough medially along the petrous apex, and it is also important to be certain your retractor fits over the true posterior ridge of the petrous bone. A modified version of the House-Urban and Fisch middle fossa retractors can be used instead of malleable retractors held by the Mayfield head holder if desired.
One recognizes this because it begins to bleed. The bleeding can be voluminous. However, since it is under low pressure, it can be controlled with Surgicel and a cottonoid held in place by the malleable retractor. The inferior limit of exposure is the inferior petrosal sinus (IPS), the posterior limit is the internal auditory canal (IAC), the lateral limit is the carotid artery (CA), and the medial limit is the superior petrosal sinus (SPS). Additional access can be obtained by decompressing the internal auditory canal as is done in a middle fossa approach for a vestibular schwannoma.
As many parapharyngeal space and nasopharyngeal tumors extend intracranially through the foramen ovale and the foramen rotundum, this maneuver allows the surgeon to separate the main tumor mass from its blood supply coming from the cavernous sinus. This makes removal of the lower portion of the tumor much simpler and safer. The internal carotid artery (ICA), oculomotor nerve, trochlear nerve, abducens nerve, and cranial nerve V1 run inside the cavernous sinus. Therefore, they are not visible unless the cavernous sinus dura is opened.