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Functional Surgery of Cerebellopontine Angle by Minimally Invasive Retrosigmoid Approach
Jacques Magnan, Bhavin Parikh, Hidemi Miyazaki
1:
Surgical Anatomy of Cerebellopontine Angle
NEUROVASCULAR ANATOMY OF POSTERIOR CRANIAL FOSSA: SUPERIOR, MIDDLE AND INFERIOR ZONES
Superior Zone
Middle Zone
Inferior Zone
OPERATIVE ENDOSCOPIC ANATOMY
Level 1
Level 2
Level 3
Level 4
ANATOMY OF INTERNAL AUDITORY MEATUS
2:
Instruments
MICROSCOPIC SET-UP
VIDEO-ENDOSCOPIC EQUIPMENT AND SET-UP
Endoscopic Equipment
MONOPOLAR AND BIPOLAR CAUTERY (FIGS 2.5 AND 2.6)
SURGICAL DRILL AND HANDPIECES
FOOT CONTROLS
GENERAL INSTRUMENT SET
MICROSURGICAL INSTRUMENTS FOR RETROSIGMOID APPROACH
Straight Dissecting Instruments
Bayonet-shaped Instruments (Figs 2.14 and 2.15)
Dissecting Scissors
CONSUMABLE MATERIALS
Neuropatch (Braun®)
Durapatch (Codman® Ethisorb™)
Bard® PTFE Teflon Felt
Fine Neurosurgical Cottonoids (Codman®)
Fibrin Glue (Tissucol®)
Bone Wax
Surgicel (Ethicon®)
SUTURE MATERIALS (FIG. 2.30)
OTHER MEDICAMENTS
OTHER DISPOSABLE MATERIALS
3:
Nerve Monitoring for Cerebellopontine Angle Surgery
INTRODUCTION
INTRAOPERATIVE CONTINUOUS COCHLEAR AND FACIAL NERVE MONITORING FOR SURGERY OF ACOUSTIC NEUROMA
Intraoperative Continuous Cochlear Nerve Monitoring by Measuring Dorsal Cochlear Nucleus Action Potentials (DNAP)
Intraoperative Continuous Facial Nerve Monitoring by Measuring Facial Nerve Root Evoked Muscle Action Potential (FREMAP)
Placement of DNAP and FREMAP Electrodes
CONTINUOUS COCHLEAR AND FACIAL NERVE MONITORING AND ITS SIGNIFICANCE
COCHLEAR NERVE MAPPING BY USING DNAP ELECTRODE
FACIAL NERVE MAPPING
SPECIAL FEATURES OF DNAP/FREMAP MONITORING INSTRUMENT
CONCLUSION
4:
Minimally Invasive Retrosigmoid Approach (MIRA)
INTRODUCTION
INDICATION
BASICS OF LATERAL SKULL BASE SURGERY
ROLE OF CADAVER DISSECTION AND KNOWLEDGE OF TEMPORAL BONE AND CPA ANATOMY
IMPORTANCE OF GOOD EXPOSURE
HEMOSTASIS DURING SURGERY
CLOSURE
ROLE OF SYSTEMATIC TRAINING AND STANDARDIZATION OF SURGICAL STEPS
SURGICAL PROCEDURE
Preoperative Patient Evaluation
Operation Theater Requirement and Setup
Anesthesia
Patient's Preparation and Position
Key Points
Incision
Craniotomy
CPA Endoscopy
ENDOSCOPE-ASSISTED MICROSURGERY
Acoustic Neuroma Surgery
Microvascular Decompression for Hemifacial Spasm and Trigeminal Neuralgia
Vestibular Neurotomy
Closure
POSTOPERATIVE CARE
POSTOPERATIVE COMPLICATIONS
Cerebrospinal Fluid Leak
Meningitis
Wound Complications
Headache
Intracranial Hemorrhage
Cerebellar Edema
Brainstem/Cerebellar Infarction
Cranial Nerve Injury
Venous Embolism
CONCLUSION
5:
Vestibular Neurotomy by Minimally Invasive Retrosigmoid Approach
INTRODUCTION
PATHOPHYSIOLOGICAL BASIS FOR VESTIBULAR NEUROTOMY
INDICATIONS FOR VESTIBULAR NEUROTOMY
SURGICAL TECHNIQUE
COCHLEAR NERVE MONITORING AND MAPPING FOR VESTIBULAR NEUROTOMY
RESULTS
Vertigo
Hearing
Immediate Follow-up
One-Year Follow-up
Five-Year Follow-up
Tinnitus
Aural Fullness
CONCLUSION
6:
Vascular Compression Syndromes
INTRODUCTION
PATHOPHYSIOLOGY
IMAGING OF NEUROVASCULAR CONFLICTS OF CPA
VASCULAR COMPRESSION SYNDROMES
Trigeminal Neuralgia: Vascular Compression Syndrome of Trigeminal Nerve
Clinical Features
MRI Findings
Therapeutic Options for Trigeminal Neuralgia
Hemifacial Spasm: Vascular Compression Syndrome of Facial Nerve
Clinical Features
Differential Diagnosis
MRI Findings
Therapeutic Options for Hemifacial Spasm
Disabling Tinnitus: Vascular Compression Syndrome of Cochlear Nerve
SELECTION CRITERIA FOR OPERATIVE TREATMENT
Clinical Criteria
Radiological Criteria
Electrophysiological Criteria
Disabling Positional Vertigo: Vascular Compression Syndrome of Vestibular Nerve
Glossopharyngeal Neuralgia: Vascular Compression Syndrome of IX, X Nerves
MICROVASCULAR DECOMPRESSION SURGERY
Indications
Vascular Decompression Technique
Identification of Neurovascular Conflict by Endoscopy
Vascular Decompression Using the Operating Microscope
Confirmation of Microvascular Decompression by Endoscopy and Nerve Monitoring
VARIATIONS IN SURGICAL TECHNIQUE IN DIFFERENT VASCULAR SYNDROMES
Microvascular Decompression for Trigeminal Neuralgia
Different Types of Conflicts Observed in MVD for Trigeminal Neuralgia
Prevention of Recurrences
MICROVASCULAR DECOMPRESSION OF HEMIFACIAL SPASM
DIFFERENT TYPES OF CONFLICTS OBSERVED IN MVD FOR HEMIFACIAL SPASM (Fig. 6.91)
Conflicts of the Youth
MICROVASCULAR DECOMPRESSION OF THE VESTIBULOCOCHLEAR NERVE
MICROVASCULAR DECOMPRESSION FOR GLOSSOPHARYNGEAL NEURALGIA
RESULTS AFTER MICROVASCULAR DECOMPRESSION SURGERY
SURGICAL RESULTS OF MVD FOR TRIGEMINAL NEURALGIA
Factors Affecting Recurrence
Complications (Table 6.3)
Remarks on Our Results
SURGICAL RESULTS OF MVD FOR HEMIFACIAL SPASM
Our Results
Complications
Conclusion
RESULTS AFTER MVD FOR UNILATERAL INCAPACITATING TINNITUS
Our Results59
Tinnitus
POSTOPERATIVE HEARING
Correlation Between Tinnitus and Hearing
Correlation Between Tinnitus and ABR
Correlation Between Tinnitus and VNG
Vascular Structures Responsible for the Conflict
Complications
Conclusion
CONCLUSION
7:
Hearing Preservation Surgery for Acoustic Neuroma
INTRODUCTION
OUR TREATMENT PHILOSOPHY IN ACOUSTIC NEUROMA SURGERY
Indication
SURGICAL TECHNIQUE
Approach
“Mapping” of Contents of CPA with Endoscope
Cochlear and Facial Nerve Monitoring and Mapping for Acoustic Neuroma Surgery
Opening of Internal Auditory Meatus
Debulking of Tumor
Dissection from Medial to Lateral
Removal of Intracanalicular Part and Endoscopic Inspection of Fundus
Final Evaluation
Closure
POSTOPERATIVE CARE
RESULTS
CONCLUSION
8:
Auditory Brainstem Implants
INTRODUCTION
INDICATION AND PATIENT SELECTION
APPLIED ANATOMY FOR THE AUDITORY BRAINSTEM IMPLANT
SURGICAL TECHNIQUE
Preoperative Decision Making for Neurofibromatosis Type 2 Patients with Bilateral Acoustic Neuroma
Approach and Tumor Removal
Endoscopic Inspection of Foramen of Luschka/Terminal Recess
Auditory Brainstem Implant
Preparation of ImplantBed for Receiver Unit
Auditory Brainstem Implant Array Insertion
Confirmation of Position of Implant by Nerve Monitoring
Final Evaluation
AUDITORY BRAINSTEM IMPLANT FOR CONGENITALLY DEAF CHILDREN WITH BILATERAL COCHLEAR NERVE APLASIA
Device Activation and Programming
Complications
Results
CONCLUSION
INDEX
TOC
Index
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