Skull base

Transotic Approach To Cerebellopontine Angle Play video

Anatomical Dissection and 2 clinical cases (left side)
Video No
10
3D
Duration
103min

1st Part: Anatomical Dissection

Lt - 75 min

  • General considerations
  • Surgical technique
  • Surgical steps and related instruments

2 nd Part: Clinical Cases

Lt – 28 min

  • Clin. Case 1: Acoustic Neuroma 2 cm (Lt - 24 min)
  • Clin. Case 2: Acoustic Neuroma 2.5 cm (Lt - 4 min)

Highlights

  1. Retroauriculo-temporal skin incision
  2. Subtotal Petrosectomy
  3. Tympanic and mastoid fallopian canal (FC) left as a bridge over the cavity
  4. Tympanic bone removed to expose the infralabyrinthine compartment of the TB
  5. Otic capsula removed to expose the complete medial surface of the TB
  6. Maximal transtemporal exposure of the internal auditory canal (IAC) and CPA
  7. Direct anterior approach to the intratemporal part of the facial nerve (FN)
  8. Dura reconstructed with musculo-facial graft
  9. Cavity obliterated with fat wedged under the FC and temporalis muscle flap

VESTIBULAR NEURECTOMY Transtemporal-Supralabyrinthine Approach (MCF) Play video

Anatomical Introduction and 3 Clinical Cases
Video No
09a
3D
Duration
70min

SURGICAL HIGHLIGHTS (MSB p.448-457)

  • Identification and exposure of the IAC
  • Renoval of meatal segment of Vest. Nerve
  • Wound closure

Transtemporal-Supralabyrinthine Approach (MCF) Play video

Anatomical Dissection (Lt side)
Video No
09
3D
Duration
53min
  • Exposure of IAC
  • Vestibular Neurectomy
  • Wound Closure

SURGICAL HIGHLIGHTS (MSB p.436-457)

  1. Preauricular skin incision with extension into temporal region
  2. Exposure of Temporal squama
  3. Craniotomy
  4. Elevation of Middle Cranial Fossa Dura
  5. Exposure of Meatal Plane
  6. Introduction of Articulated Middle Fossa Retractor
  7. Identification of blue line of Superior Semicircular canal
  8. Identification and exposure of the Internal Auditory Canal
  9. Removal of the meatal segment of vestibular nerve
  10. Wound closure: sealing of internal auditory canal
  11. Recontruction of tegmen tympani
  12. Suspension of middle cranial fossa dura from temporalis muscle
  13. Repositioning of the craniotomy flap
  14. Suction drain
  15. Skin closure

Infratemporal Fossa Approrach Type D Play video

Anatomical Dissection (right side) and 3 Clinical Cases
Video No
08
3D
Duration
71min
  • Anatomical Dissection: 2D with 3D-upscaling (Rt 14 min)
  • Clin.case 1: Parapharyngeal Neurofibroma (Lt 17 min)
  • Clin.case 2: Parapharyngeal Pleomorphic Adenoma (Lt 24 min)
  • Clin.case 3: Arachnoid Cyst of Ala magna of sphenoid bone (Lt 12 min)

SURGICAL HIGHLIGHTS

  1. Preauricular skin incision with extension into the neck and toward the orbit
  2. Exposured of FN in the parotid
  3. Elevation of temporal muscle
  4. Exposure of zygomatic arch and lateral orbital rim
  5. Division and reflection of zygomatic arch
  6. Anterior elevation of temporalis muscle
  7. Removal of posterior root of zygomatic arch
  8. Inferior displacement of mandibular condyle
  9. Removal of bone at the base of MCF (incl. tuberculum articulare)
  10. Separation of soft tissues from base of MCF
  11. Exposure of pterygoid process
  12. Exposure of pterygopalatine fossa
  13. Exposure of F. rotundum and V2 in upper sphenopalatine fossa
  14. Exposure of sphenoid sinus
  15. Exposure of F. rotundum and V2 in upper sphenopalatine fossa
  16. Elevation of dura from base of MCF for exposure of trigeminal ganglion with V3 and V2
  17. Opening of sphenoid sinus
  18. Entering nasal cavity
  19. Exposure of foramen lacerum
  20. Exposure of cavernous sinus
  21. Obliteration of the cavity and wound closure (not shown)

Infratemporal Fossa Approach Type C Play video

Video No
07
3D
Duration
75min

Part 1: Anatomical Dissection (right side)

Part 2: Clinical Cases (Case 1 and 2)

Highlights (MSB p. 350)

  1. Retroauriculo-temporal skin incision
  2. Frontal branch of VII exposed
  3. Zygomatic arch, temporalis muscle inferiorly displaced
  4. Subtotal petrosectomy
  5. meningeal artery and mandibular branch of Vth nerve sectioned
  6. Inferior displacement of mandibular condyle
  7. Pterygoid process and surrounding bone at the skull base removed
  8. Maxillary branch of the trigeminal nerve (V) divided
  9. Exposure of the internal carotid artery from carotid foramen to foramen lacerum and cavernous sinus
  10. Exposure of infratemporal fossa, pterygopalatine fossa, parasellar region and nasopharynx for tumor removal
  11. Zygomatic arch rewired into place
  12. Operative cavity obliterated with temporalis, retroauriculo-occipital or sternocleidomastoid muscle flaps

Infratemporal Fossa Approach Type B Play video

Anatomical Dissection (right side) and 3 clinical cases
Video No
06
3D
Duration
75min

2ndt Part Clinical Cases

Case 1: Removal of apical cyst (Lt 22 min)

Case 2: Drainage of apical cyst (Rt 10 min)

Case 3: lRemoval of epidermoid cyst – apical cholesteatoma (Rt 11 min)

Highlights

  1. Retroauriculo-temporal skin incision
  2. Main trunk and frontal branch of the facial nerve identified
  3. Zygomatic arch and temporalis muscle reflected inferiorly
  4. Subtotal petrosectomy
  5. Horizontal intratemporal carotid artery, middle meningeal artery and mandibular nerve exposed by removal of mandibibular tubercle
  6. Mandibular condyle displaced inferiorly
  7. Pyramid tip and clivus exposed for tumor removal
  8. Wound obliterated with temporalis muscle

Infratemporal fossa approach type A for removal of a C3 paraganglioma Play video

Left side
Video No
05
3D
Duration
50min

Highlights:

  1. Information with Figures (6 min)
  2. Separation of superior pole of tumor (2 min)
  3. Separation of posterior pole of tumor (1 min)
  4. Exposure of inferior tumor pole (3 min)
  5. Exposure of anterior tumor pole (3 min)
  6. Separation of tumor from ICA and cranial nerves at the jugular foramen (2 min)
  7. Removal of tumor along vertical intrapetrous segment of ICA (4 min)
  8. Removal of tumor from otic capsula (1 min)
  9. Removal of tumor from the pyramid apex (2 min)
  10. Removal of tumor remnants in the spongiotic bone (3 min)
  11. Removal of last portion of tumor at the carotid bend (6 min)
  12. Further removal of infiltrated spongiotic bone (12 min)
  13. Final view after tumor removal(1 min)
  14. Operative specimen and wound closure (1 min)

Facial nerve surgery 2 Play video

Part 1-2
Video No
04b
3D
Duration
45min

Part 1: Combined transtemporal-transmastoid approach with meato-tympanic Rerouting and double grafting of theFacial Nerve after Longitudinal Fracture of the Temporal Bone (Right side 27 min)

Highlights:

  1. Introduction with Figures ( 5 min)
  2. Transmastoid Approach (4 min):
    1. exposure of mastoid, pyramidal and tympanic segments of the Facial Nerve (1 min)
    2. Identification of Facial Nerve lesion (3 min)
  3. Transtemporal (MCF) Approach (5 min):
    1. exposure of genu and labyrinthine segment of the Facial Nerve (4 min)
    2. meato-tympanic rerouting of Fallopian canal (1 min)
  4. Transmastoid approach (1 min): elevation of proximal stump of FN and enlargement of the Fallopian canal with the drill
  5. Transtemporal (MCF) Approach (4 min):
    1. decompression of lateral cistern of the posterior fossa (1 min)
    2. section of petrosal nerve distal to geniculum and of labyrinthine segment of the FN (1 min)
  6. Measurement, Harvesting and preparation of graft from the greater auricular nerve (2 min)
  7. Transmastoid Approach (1 min): introduction of double nerve graft
  8. Transtemporal (MCF) Approach (4 min):
    1. double grafting of proximal stump of the FN (3 min)
    2. wound closure with free muscle graft and craniotomy flap (1 min)
  9. Transmastoid approach: double grafting of distal stump of the FN (2 min) 
  10. Combined Transtemporal-Transmastoid Approach final situation (1 min)

Part 2: Subtotal Petrosectomy with removal of the otic capsula , meato-cochleo-mastoid rerouting and grafting of the Facial Nerve after transverse fracture of the Temporal Bone (Right side 18 min)

Highlights:

  1. Introduction with figures (5 min)
  2. Mastoidectomy with exposure of fracture line from oval window to supralabyrinthine recess (2 min)
  3. Identification of traumatized tympanic segment of Facial Nerve (30 sec)
  4. Removal of otic capsula leaving the medial portion of the basal turn (1 min)
  5. Section of petrosal nerve and mobilization of the swollen labyrinthine segment of the Facial Nerve (1 min)
  6. Harvesting and preparation of the nerve graft (greater auricular nerve) (1 min)
  7. Drilling new meato-cocleo-mastoid Fallopian canal (1 min)
  8. Preparation of proximal stump of the Facial Nerve for grafting (30 sec)
  9. Preparation of distal stump of the Facial Nerve for grafting (30 sec)
  10. Introduction of single nerve graft (30 sec)
  11. Proximal coaptation of nerve graft (2 min)
  12. Distal coaptation of nerve graft (3 min)
  13. Wound closure (30 sec)

Facial nerve surgery 1 Play video

Subtotal Petrosectomy with tympano-mastoid double grafting after iatrogenic injury of the Facial Nerve (Right side)
Video No
04a
3D
Duration
37min

Highlights:

  1. Preoperative information incl. radiology ( 2 min)
  2. Mastoidectomy (3 min)
  3. Canalplasty (3 min)
  4. Identification of traumatized Facial Nerve (3 min)
  5. Decision to perform Subtotal Petrosectomy with preservation of otic capsule (3 min)
  6. Exposure of traumatized Facial Nerve (1 min)
  7. Exenteration of hypotympanic and infralabyrinthine pneumatic cells (1 MIN)
  8. Obliteration of Eustachian tube (2 min)
  9. Preparation of Facial Nerve for grafting (6 min)
  10. Preparation of Nerve graft (1 min)
  11. Tympano-mastoid double grafting of Facial Nerve (8 min)
  12. Wound closure (2 min)

Infratemporal fossa Approach Type A for removal of a C2De2Di1 jugular Schwannoma Play video

Left side
Video No
03
3D
Duration
82min

Highlights:

  1. Introduction and preoperative radiology (6 min)
  2. Subtotal Petrosectomy (7 min)
  3. Exposure and mobilization of the intrapetrousFacial Nerve (5 min)
  4. Anterior transposition of the Facial Nerve (18 min)
  5. Exposure and ligation of Sigmoid Sinus (4 min)
  6. Exposure of ICA at the skull base (4 min)
  7. Introduction of infratemporal fossa retractor (1 min)
  8. Exposure of inferior tumor pole (1 min)
  9. Mobilization of superior tumor pole (5 min)
  10. Obliteration of Isthmus of the Eustachian Tube (1 min)
  11. Separation of anterior tumor pole from ICA (4 min)
  12. Mobilization of posterior tumor pole (2 min)
  13. Mobilization of inferior tumor pole (4 min)
  14. Separation of medial tumor extension from the posterior fossa dura (5 min)
  15. Removal of intradural tumor extension (7 min)
  16. Wound closure (2 min)
  17. Postoperative radiology (1 min)