Otologic Surgery

Description

Front Matter Copyright Dedication In Memoriam Contributors Acknowledgments Chapter 1 1 - Otologic Instrumentation Operating Room Stapes Surgery Tympanoplasty with Mastoidectomy Endoscopic Middle Ear Surgery Endolymphatic Sac Surgery Neurotologic Procedures Middle Fossa Surgery Conclusion Appendix 1-1. Instruments and Equipment for Otologic Surgery General Operating Room Equipment Stapes Surgery Chronic Ear Surgery Endolymphatic Sac Surgery Neurotologic Surgery Middle Cranial Fossa Surgery Chapter 2 2 - Canalplasty for Exostoses of the External Auditory Canal and Miscellaneous Auditory Canal Problems Surgical Indications Preoperative Preparation Patient Preparation Canalplasty for Exostoses of the External Auditory Canal and Miscellaneous Auditory Canal Problems Psychological Preparation Pharmacologic Preparation Site Preparation Analgesia Surgical Technique Removal of Posterior Exostosis Removal of Anterior Exostosis Postoperative Care Problems and Complications Summary Miscellaneous External Auditory Canal Conditions Medial Third Stenosis Collapsing Canal Keratosis Obturans Osteonecrosis and Osteoradionecrosis of the Tympanic Bone Scutum Defects Post-Traumatic Suture Dehiscence Chapter 3 3 - Malignancies of the Temporal Bone: Limited and Radical Temporal Bone Resection Malignancies of the Temporal Bone: Limited and Radical Temporal Bone Resection History and Physical Examination Biopsy Diagnostic Tests Staging Surgical Treatment Partial Temporal Bone Resection Subtotal Temporal Bone Resection Total Temporal Bone Resection Selection of Surgical Procedure Reconstruction Complications Radiation Chemotherapy Rehabilitation of Lower Cranial Nerve Deficits Conclusion Chapter 4 4 - Congenital Malformation of the External Auditory Canal and Middle Ear Congenital Malformation of the External Auditory Canal and Middle Ear Classification Systems Initial Evaluation and Patient Selection Timing of Surgical Repair Preoperative Evaluation and Patient Counseling Surgical Technique Patient Positioning and Preparation Incision Canalplasty Drilling Skin Graft Harvest Meatoplasty Rib Graft Microtia Repair Medpor Repair Fascia Grafting Skin Graft Placement Closure Rib Graft Microtia Repair Medpor Repair Postoperative Care Pitfalls Results Complications and their Management Sensorineural Hearing Loss Facial Nerve Injury Conductive Hearing Loss Otorrhea Stenosis Summary Chapter 5 5 - Surgery of Ventilation and Mucosal Disease Terminology Acute Otitis Media Without Effusion Acute Otitis Media with Effusion Otitis Media with Effusion Chronic Suppurative Otitis Media Idiopathic Hemotympanum Epidemiology Risk Factors Microbiology Pathophysiology Acute Otitis Media Chronic Otitis Media with Effusion Nose Middle Ear Space Eustachian Tube Idiopathic Hemotympanum Treatment and Patient Selection Acute Otitis Media and Recurrent Acute Otitis Media Chronic Otitis Media with Effusion Antimicrobial Therapy Antihistamines and Decongestant Therapy Antileukotrienes Corticosteroid Therapy Food Allergy Immunotherapy Surgical Therapy Adenoidectomy Mastoidectomy Patient Counseling Benefits Limitations Risks and Complications Idiopathic Hemotympanum Surgical Technique Preoperative Preparation Surgical Site Preparation and Draping Tympanostomy Tubes Mastoidectomy Adenoidectomy Instruments Tympanostomy Tubes Adenoidectomy Mastoidectomy Technical Details Tympanostomy Tube Insertion Laser Myringotomy Adenoidectomy Mastoidectomy Postoperative Care and Follow-Up Tympanostomy Tubes Adenoidectomy Mastoidectomy Surgical Pitfalls Tympanostomy Tubes Adenoidectomy Mastoidectomy Results Complications and Management Tympanostomy Tubes Otorrhea Persistent Perforation Adenoidectomy Bleeding Velopharyngeal Insufficiency Mastoidectomy Facial Paralysis Hearing Loss Recurrent Hemotympanum Alternative Techniques Allergy Treatment Biofilms Eustachian Tuboplasty Guidelines for the Management of Acute Otitis Media and Otitis Media with Effusion Chapter 6 6 - Diagnosis and Management of the Patulous Eustachian Tube Diagnosis and Management of the Patulous Eustachian Tube Etiology and the Clinical Presentation Diagnosis Treatment 1. Irritating the Eustachian Tube Mucosa 2. Procedures Targeting the Tympanic Membrane 3. Surgical Augmentation of the Eustachian Tube Wall Submucosal Augmentation with Injection of Hydroxyapatite Pitfalls 4. Patulous Eustachian Tube Repair by Insertion of an Intraluminal Shim Pitfalls Pitfalls 6. Complete Obliteration of the Eustachian Tube Lumen 7. Procedures Targeting the Palate Conclusion Chapter 7 7 - Office Management of Tympanic Membrane Perforation and the Draining Ear Chronic Suppurative Otitis Media Definition Etiology Office Management of Tympanic Membrane Perforation and the Draining Ear Bacteriology Pathophysiology Acute Otitis Media with an Open Tympanic Membrane Granular Myringitis Management of Otorrhea Aural Toilet Antimicrobial Therapies Granulation Tissue Preventing Bacterial Resistance Causes of Failed Therapy Office Techniques for Closure of Tympanic Membrane Perforations Cauterization and Paper Patching Fat Graft Tympanoplasty Otorrhea from Cerebrospinal Fluid Fistula Chapter 8 8 - Tympanoplasty: Outer Surface Grafting Technique Historical Aspects Patient Selection and Evaluation Patient Counseling Preoperative Preparation Preparation in the Operating Room Anesthesia Arrangement and Instrumentation Surgical Technique Transmeatal Incisions Postauricular Exposure and Removal of Fascia Removal of the Canal Skin Enlargement of the Ear Canal Deepithelialization of the Tympanic Membrane Remnant Preparation of Packing Placement of Fascia Replacement of Canal Skin Closure and Replacement of the Vascular Strip Postoperative Care Pros and Cons of Outer Surface Technique Healing Problems Lateralization of the Tympanic Membrane Blunting in the Anterior Sulcus Other Problems Appendix 8-1Risks and Complications of Myringoplasty, Tympanoplasty, Mastoid Surgery, and Other Operations For Correction of Chr... Ear Infection Loss of Hearing Tinnitus Dizziness Taste Disturbance and Mouth Dryness Facial Paralysis Hematoma General Anesthesia Complications Complications Related to Mastoid Surgery Appendix 8-2Postoperative Instruction Folder: Myringoplasty, Tympanoplasty, and Mastoidectomy Precautions Dizziness Hearing Discharge Pain Eardrops Chapter 9 9 - Cartilage Tympanoplasty Patient Selection Surgical Technique General Considerations Perichondrium and Cartilage Island Flap Palisade and Mosaic Technique Postoperative Care Problems and Pitfalls Intraoperative Complications Postoperative Complications Results Conclusion Chapter 10 10 - Tympanoplasty—Undersurface Graft Technique: Transcanal Approach Preoperative Evaluation and Patient Selection Graft Selection Tympanoplasty—Undersurface Graft Technique: Transcanal Approach Surgical Technique Preparation Surgical Evaluation Injection Visibility: Canal Enlargement and Speculum Placement Perforation Preparation Canal Incisions and Middle Ear Exposure Perichondrial Graft Middle Ear Preparation Graft Placement and Stabilization External Canal Packing Postoperative Care Chapter 11 11 - Tympanoplasty—Undersurface Graft Technique: Postauricular Approach Historical Aspects Preoperative Fundamental Principles Fundamentals Traditional Objectives Predisposing Conditions Adenoidal Hypertrophy and Adenoidectomy Nasal Or Sinus Condition Allergy Rare Disorders Preoperative Preparation Otorrhea Eustachian Tubal Tests Imaging Complications Informed Consent Basic Technical Principles Infection Control Hemostasis Grafting Techniques and Exposure Mastoidectomy Ossicular Reconstruction Facial Nerve Monitoring Surgical Technique Surgical Preparation Anesthesia Incisions Harvesting Fascia Exposing the Middle Ear Eradication of Disease Preparation of the Tympanic Membrane Remnant Placement of the Graft Postoperative Care Results Cartilage Graft Tympanoplasty Surgical Techniques Results Summary Chapter 12 12 - Ossicular Reconstruction Ossicular Reconstruction Patient Selection and Evaluation Surgical Considerations Prosthesis Selection Surgical Technique Exposure and Assessment Cartilage Preparation Placement of Prosthesis Postoperative Care Factors that Make a Difference Summary Chapter 13 13 - Canal Wall Reconstruction Tympanomastoidectomy Rationale for the CWR Approach Canal Wall Reconstruction Tympanomastoidectomy Patient Selection Patient Preparation Surgical Technique Mastoidectomy: Special Considerations Reconstruction Postoperative Care Potential Pitfalls Hearing Results Summary Chapter 14 14 - Surgery of Acute Infections and Their Complications Etiology and Pathogenesis Virus and Bacterial Interactions Acute Otitis Media Bacteria, Nasopharyngeal Colonization, Eustachian Tube Assent Chronic Suppurative Otitis Media Bacteria, With and Without Cholesteatoma Future Answers from Genetics and Molecular Biology Surgery of Acute Infections and Their Complications Clinical Presentation and Diagnosis Signs of Impending Complications Systematic Diagnostic Approaches Obvious Complications Facial Paralysis Labyrinthitis Meningitis Mastoiditis Predictable Patterns of Complications Less Obvious Complications Masked Mastoiditis Bezold’s or Luc Abscesses Subdural Abscess Otitic Hydrocephalus Petrositis Brain Abscess Treatment First Steps: Determine Intracranial Involvement Ear Management For Intracranial Involvements Specific Management of Intracranial Complications Brain Abscess OTITIC Hydrocephalus Sigmoid Sinus Thrombophlebitis Subdural Abscess Specific Management of Intratemporal Complications Facial Paralysis in Acute Otitis Media Facial Paralysis in Chronic Suppurative Otitis Media, with or Without Cholesteatoma Labyrinthitis Petrositis Mastoiditis Summary Chapter 15 15 - Mastoidectomy: Intact Canal Wall Procedure Definitions Radical Mastoidectomy Modified Radical Mastoidectomy Tympanoplasty with Mastoidectomy Evolution of Technique Controversy Indications for Mastoidectomy Indications for Exteriorized Mastoid Cavity Preoperative Decisions Intraoperative Decisions Preoperative Evaluation and Treatment Treatment of a Chronically Draining Ear Preoperative Counseling Preoperative Preparation of the Patient Surgical Technique Removal of Middle Ear Disease Mastoid Exenteration Opening the Facial Recess Elimination of Disease Use of Pl astic Sheeting Completion of the Operation Dressing and Postoperative Care Facial Nerve in Surgery of Chronic Otitis Media Tympanic Segment Mastoid Segment Management of the Labyrinthine Fistula Repair of Canal Wall Defects Defects Resulting from Disease Defects Resulting from Surgery Chapter 16 16 - Mastoidectomy: Canal Wall Down Procedure Modified Radical Mastoidectomy (Bondy) Radical Mastoidectomy Tympanoplasty with Canal Wall Down Mastoidectomy Atticotomy Mastoid Obliteration Procedure Mastoid Reconstruction Procedure Indications for Canal Wall Down Mastoidectomy Mastoidectomy: Canal Wall Down Procedure Decision Making Preoperative Evaluation Preoperative Counseling Surgical Techniques Patient Preparation Basic Techniques Adequate Saucerization Adequate Lowering of the Facial Ridge Management of the Mastoid Tip Adequate Meatoplasty Bondy Modified Radical Mastoidectomy Canal Wall Down Mastoidectomy with Tympanoplasty Atticotomy Radical Mastoidectomy Mastoid Obliteration Procedure Reconstruction of a Radical Cavity Revision Canal Wall Down Surgery Postoperative Care Potential Pitfalls Dural Venous Sinuses Facial Nerve Facial Nerve Monitoring Outcomes Chapter 17 17 - Tympanoplasty: Staging and Use of Plastic Postoperative Collapse of the Tympanic Membrane Indications for Staging Mucosal Disease Factors Ossicular Chain Factors Residual Cholesteatoma Factor Timing the Second Stage Preoperative Evaluation and Counseling Plastic in the Middle Ear Plastic Sheeting Mucous Membrane Indications Canal Wall Down Procedures Plastic Extrusion Controversy Chapter 18 18 - Complications of Surgery for Chronic Otitis Media Labyrinthine Fistula Secondary to Chronic Otitis Media Complications of Surgery for Chronic Otitis Media Intraoperative Management of Labyrinthine Fistulas Iatrogenic Labyrinthine Fistula Sensorineural Hearing Loss Facial Nerve Injury Facial Nerve Grafting Ossiculoplasty Complications Dural Injury Vascular Injury Sigmoid Sinus Superior Petrosal Sinus Jugular Bulb Carotid Artery Summary Chapter 19 19 - Dural Herniation and Cerebrospinal Fluid Leaks Dural Herniation and Cerebrospinal Fluid Leaks Diagnosis Treatment Chapter 20 20 - Total Stapedectomy Selection of Patients for Stapes Surgery Indications for Stapes Surgery Total Stapedectomy Surgical Technique Step 1 Step 2 Step 3 Step 4 Postoperative Care Intraoperative Pitfalls Chorda Tympani Nerve Eardrum Perforation Malleus Fixation Facial Nerve Abnormalities Floating Footplate Solid or Obliterated Footplate Obliterated Footplate Round Window Closure Owing to Otosclerosis Perilymph Gusher Intraoperative Vertigo Deep Oval Window Summary Authors’ Note Chapter 21 21 - Laser Stapedotomy Patient Counseling Surgery Operating Room Setup and Preparation Laser Stapedotomy Special Conditions Overhanging Facial Nerve Obliterative Otosclerosis Floating Footplate Intraoperative Complications Tympanic Membrane Perforation Dislocated Incus Chorda Tympani Nerve Injury Postoperative Care Results Success Rate Postoperative Complications Patient Selection Pitfalls Chapter 22 22 - Partial Stapedectomy History Surgical Technique: Local Anesthesia with Intravenous Sedation, Except in Young Children Modifications of the Cup-Piston Stapes Prosthesis Indications for Cup-Piston Prosthesis Postoperative Results Discussion Comparison with Wire Stapes Prosthesis Stainless Steel Prostheses Versus Polytef (Teflon) Prostheses Juvenile Otosclerosis Summary Chapter 23 23 - Laser Revision Stapedectomy Laser Revision Stapedectomy History of Revision Stapedectomy Background L aser Comparison of L asers Laser Use: 1990s to 2013 Analysis of Failed Stapes Surgery Case for Use of Lasers in Revision Stapes Surgery Limitations of Lasers Technique Summary Chapter 24 24 - Special Problems of Otosclerosis Surgery Intraoperative Audiometry Routine Stapedectomy Intraoperative Problems Tympanomeatal Flap Tear Tympanic Membrane Perforation Atrophic Tympanic Membrane Ossicular Dislocation Fixed Malleus Fused Incudostapedial Joint Partial Absence of the Incus Dehiscent Facial Nerve Obliterative Otosclerosis Narrow Oval Window Niche and Promontory Drilling Floating Footplate Revision Stapedectomy Sensorineural Hearing Loss Conductive Hearing Loss Surgical Technique Surgical Findings Incus Erosion Prosthesis Malfunction Negative Findings Malleus Fixation Other Findings Fistula Small Fenestra Recommendations Far Advanced Otosclerosis Surgical Technique Results Stapedectomy for Small Air-Bone Gaps Stapedectomy in Children Stapedectomy in Elderly Patients Stapedectomy in Pilots Stapedectomy in Patients with Chronic Otitis Media Findings in Bilateral StapedectomY Chapter 25 25 - Avoidance and Management of Complications of Otosclerosis Surgery Preoperative Evaluation Medical Conditions Physical Examination Informed Consent Operating Room Surgical Technique Prerequisites for Residents Prosthesis Type, Size, and Availability Laser Stapedotomy Versus Drill Stapedotomy Stapedectomy Versus Stapedotomy Stapedotomy Site Footplate/Vestibular Relationships Laser Type Local Versus General Anesthesia Stapedotomy in Children Prosthesis Ballottement Prosthesis Displacement at Stapedotomy Oval Window Seal Tympanic Membrane Perforation and Flap Tear Incus Dislocation Malleus and Incus Fixation Persistent Stapedial Artery and Vascular Anomalies Tympanosclerosis Osteogenesis Imperfecta Congenital Stapes Fixation or Abnormality Round Window Obliteration Overhanging Facial Nerve Narrow Oval Window Niche Congenitally Ectopic Facial Nerve Biscuit Footplate Obliterative Otosclerosis Perilymphatic Gusher Fractured Footplate Footplate Fragments in the Vestibule Blood Within the Vestibule Sensorineural Hearing Loss Acute Otitis Media Barotrauma Dysgeusia Delayed Facial Nerve Paralysis Hyperacusis Binaural Diplacusis Otosclerotic Inner Ear Syndrome Sensorineural Hearing Loss Progression Serous Labyrinthitis Vestibular Complaints Wound Infection Upper Respiratory Infection Surgical Management Adhesions Acute Facial Nerve Paralysis Conductive Hearing Loss Prosthesis Displacement Incus Necrosis Prosthesis Extrusion Otosclerotic Regrowth Wire Loop Prosthesis Long Prosthesis Overinsertion Loose Prosthesis Syndrome Perilymphatic Fistula Reparative Granuloma Introduced Ectopic Tissue Surgical Risk Reduction in Revision Surgery Conclusion Chapter 26 26 - Perilymph Fistula: Otic Capsule Defects Not Seen With Imaging Peripheral Vestibular Physiology and the Need for a Precise Lexicon Perilymph Fistula: Otic Capsule Defects Not Seen With Imaging Autonomic Dysfunction Cognitive Dysfunction Altered Spatial Orientation Anxiety Sound-Induced Gravitational Receptor Dysfunction Type of Vertigo Autophony Migraine and Gravitational Receptor Dysfunction Type of Vertigo What is A Perilymph Fistula Preoperative and Intraoperative Diagnosis of Perilymph Fistula Tuning Fork Testing Vestibular Evoked Myogenic Potentials Posturography and Pressure Tests Audiometry and Electrocochleography Audiometry Electrocochleography Intraoperative Visualization of Fluid Quest for a Diagnostic Marker in Perilymph Fluorescein Protein Markers History of Perilymph Fistula and Outcomes History Outcomes Recurrent Perilymph Fistula Surgical Management Patient Counseling Surgical Procedure Surgical Technique Preoperative Preparation Surgical Instruments Donor Site Management Tympanostomy Tube Placement and Approach to the Middle Ear Laser Use in Preparing the Sites for Placement of the Reinforcement Materials Round Window and Oval Window Reinforcement Techniques Using Loose Areolar Tissue Grafts Round Window Reinforcement Technique Using a Conchal Cartilage Graft Postoperative Care Summary Chapter 27 27 - Management of Bell’s Palsy and Ramsay Hunt Syndrome Bell’s Palsy Ramsay Hunt Syndrome Facial Nerve Decompression for Bell’s Palsy Preoperative Preparation Surgical Technique Postoperative Care Limitations and Special Considerations Summary Chapter 28 28 - Traumatic Facial Paralysis Intracranial Injury to the Facial Nerve Intratemporal Injury to the Facial Nerve Extratemporal Injury to the Facial Nerve Patient Evaluation Prognosis Based on Electric Studies Radiological Evaluation Timing of Surgery Associated Trauma Ossicular Damage Traumatic Otorrhea Surgical Treatment Preoperative Preparation Patient Positioning Technique Intratemporal Nerve Segment Extratemporal Nerve Segment Postoperative Care Pitfalls of Surgery Results Complications Chapter 29 29 - Facial Nerve Tumors Patient Selection Observation Radiation Therapy and Radiosurgery Patient Counseling Surgical Techniques Middle Fossa Approach Transmastoid Approach Translabyrinthine Approach Tumor Removal Graft Material Nerve Grafting Rerouting Pitfalls of Surgery Results Facial Nerve Neuromas Facial Nerve Hemangiomas Complications and Management Chapter 30 30 - Surgery for Cochlear Implantation Patient Selection Medical Evaluation Audiological Assessment Physical Examination Imaging Promontory Evaluation Selection of Ear Hearing Preservation in Cochlear Implantation Surgical Technique Complications Revision Cochlear Implantation Bilateral Cochlear Implantation COMBINED ELECTROACOUSTIC STIMULATION Chapter 31 31 - Pediatric Auditory Brainstem Implantation Introduction Patient Selection Preoperative Evaluation and Counseling Anatomical and Surgical Considerations Implantation Technique Postoperative Care Postoperative Complications Results Conclusion Chapter 32 32 - Implantable Hearing Devices Requirements of Implantable Devices Conventional Versus Implantable Hearing AIDS Types of Middle Ear Implants History of Middle Ear Implants Specific Devices Rion Totally Implantable Communication Assistance Implex Vibrant Soundbridge Soundtec and Ototronix Maxum Envoy Esteem Middle Ear Transducer Conclusion Chapter 33 33 - Bone-Anchored Cochlea Stimulator Hearing Through Bone Conduction Bone-Anchored Cochlea Stimulator Osseointegration Patient Selection Conductive or Mixed Hearing Loss Chronic Ear Disease Congenital Malformations Conductive Loss in the Only Hearing Ear Chronic External Otitis or Chronic Otitis Media Preventing the use of an Air Conduction Hearing Aid Patients with Down Syndrome Single-Sided Deafness Patient Counseling Bone-Anchored Cochlea Stimulator Models and Audiometric Criteria Contraindications Implant Characteristics Surgical Treatment Preparation of the Patient Surgical Instruments Surgical Technique Bone-Anchored Cochlea Stimulator Surgery with Soft Tissue Reduction Guide-Hole Drilling Countersink Drilling Subcutaneous Soft Tissue Reduction Placing the Bone-Anchored Cochlea Stimulator Implant and Coupling Suturing the Flap Bone-Anchored Cochlea Stimulator Surgery without Soft Tissue Reduction Postoperative Management Pitfalls and ComplicationS in Surgery and During Follow-Up Flap Necrosis Adverse Skin Reactions Implant Stability Handling of Complications Complications Related to Bone Complications Related to Soft Tissue Fitting Procedure Baha in Children Surgical Aspects New Developments in Bone Conduction Prostheses Nonsurgical Bone Conduction Prosthesis Summary Chapter 34 34 - Surgery of the Endolymphatic Sac Surgery of the Endolymphatic Sac Endolymphatic Sac Physiology Endolymphatic Hydrops: Pathophysiology Epidemiology Diagnosis Treatment Medical Treatment Intratympanic Treatment Surgical Treatment Endolymphatic Sac Surgery Patient Selection Endolymphatic Shunt Procedure Complications Vestibular Outcomes Endolymphatic Sac Procedures 1995 to Present Patient’s Perspective—Outcomes Questionnaires Hearing Outcomes Chapter 35 35 - Middle Fossa Vestibular Neurectomy Indications for Middle Cranial Fossa Vestibular Neurectomy Symptoms Patient Type Surgical Technique Patient and Surgical Team Position Instrumentation Surgical Technique Methods to Locate the Internal Auditory Canal Postoperative Care and Hospitalization Postoperative Complications Extradural Hematoma Facial Paresis or Paralysis Cerebral Spinal Fluid Leak Subcutaneous Hematoma Meningitis Results Conclusions Facial and Cochlear Nerve Monitorization Chapter 36 36 - Retrolabyrinthine and Retrosigmoid Vestibular Neurectomy Retrolabyrinthine and Retrosigmoid Vestibular Neurectomy Preoperative Evaluation Pertinent Neuroanatomy Retrolabyrinthine Approach Retrosigmoid or Suboccipital Approach Combined Retrolabyrinthine-Retrosigmoid Approach Endoscopic-Assisted Vestibular Neurectomy Postoperative Course Efficacy Complications Chapter 37 37 - Translabyrinthine Vestibular Neurectomy Introduction History Diagnostic Considerations Treatment of Vestibular Disorders: an Overview Decision Making Transmastoid Labyrinthectomy Versus Translabyrinthine Vestibular Nerve Section for Deafferentation Preoperative Testing Functional Vestibular System Assessment Electronystagmography Vestibular Evoked Myogenic Potentials Platform Posturography Functional Auditory System Assessment Anatomical Vestibular and Auditory System Assessment Magnetic Resonance Imaging High-Resolution Computed Tomography Surgical Procedure Postoperative Care and Follow-Up Complications Results and Literature Overview Conclusion Chapter 38 38 - Transmastoid Semicircular Canal Occlusion for Benign Paroxysmal Positional Vertigo and Other Disorders Pathophysiology Preoperative Patient Counseling and Conservative Management Surgical Patient Selection Preoperative Evaluation Surgical Technique Results Further Applications of Canal Occlusion Surgery Summary Chapter 39 39 - Cochleosacculotomy Physiological, Anatomical, and Pathological Rationale Patient Selection Surgical Technique Results Chapter 40 40 - Transcanal Labyrinthectomy Patient Selection Preoperative Evaluation Preoperative Patient Counseling and Informed Consent Surgical Technique Incision and Exposure Preparation for Opening the Vestibule Removal of Vestibular End Organs Postoperative Care Cerebrospinal Fluid Leakage Failure to Find the Utricle Facial Nerve Injury Postoperative Complications Incomplete Labyrinthectomy Histopathology of Labyrinthectomy Results of Surgery Special Considerations Chapter 41 41 - Chemical Treatment of the Labyrinth Intramuscular Application of Streptomycin Clinical Studies Indications Pretreatment Evaluation and Patient Counseling Treatment Technique Results Intratympanic Gentamicin Therapy Experimental Studies Review of Clinical Studies Detailed Description of One Technique Results OF DETAILED TECHNIQUE Treatment of Labyrinthine Disorders with Intratympanic Corticosteroids Experimental Studies Clinical Studies Systems for Drug Delivery to the Inner Ear Summary Chapter 42 42 - Superior Semicircular Canal Dehiscence Syndrome Diagnostic Evaluation Differential Diagnosis Preoperative Decision Making Bilateral Dehiscences Operative Technique Postoperative Care Long-Term Results Summary Chapter 43 43 - Overview of Transtemporal Skull Base Surgery Overview of Transtemporal Skull Base Surgery Nomenclature Collaboration in Transtemporal Surgery Complex Case Selection Summary Chapter 44 44 - Operations for Vascular Compressive Syndromes Preoperative Evaluation Trigeminal Neuralgia Patient Selection Operative Technique for Microvascular Trigeminal Decompression Results for Trigeminal Microvascular Decompression Complications Hemifacial Spasm Patient Selection Operative Technique for Microvascular Decompression in Hemifacial Spasm Results from Microvascular Decompression in Hemifacial Spasm Complications GLossopharyngeal Neuralgia Patient Selection Operative Technique for Microvascular Disease in Glossopharyngeal Neuralgia Results of Microvascular Decompression in Glossopharyngeal Neuralgia Complications of Microvascular Disease in Glossopharyngeal Neuralgia Summary Chapter 45 45 - Drainage Procedures for Petrous Apex Lesions Presenting Symptoms Patient Selection Preoperative Evaluation and Patient Counseling Surgical Techniques Infralabyrinthine Approach to the Petrous Apex Pitfalls Transcanal Infracochlear Approach to the Petrous Apex Pitfalls Results Complications and Management Endoscopic Transsphenoidal Approach to Petrous Apex Lesions Subtotal Petrosectomy Middle Fossa Drainage of the Petrous Apex Conclusion Chapter 46 46 - Surgery for Glomus Tumors and Other Lesions of the Jugular Foramen Tympanic Tumor Tympanomastoid Tumor Jugular Bulb Tumor Carotid Artery Glomus Tumor Transdural Tumor Surgery for Glomus Tumors and Other Lesions of the Jugular Foramen Glomus Vagale Tumor Jugular Foramen Schwannoma Preoperative Evaluation Routine Hearing Tests Computed Tomography Magnetic Resonance Imaging Arteriography Nuclear Medicine Studies Genetics of Paragangliomas and Considerations for Multicentric Lesions Brain Perfusion and Flow Studies Embolization Biopsy Patient Counseling Surgical Approaches Transcanal Approach Mastoid–Extended Facial Recess Approach Mastoid-Neck Approach Mastoid-Neck with Limited Facial Nerve Rerouting Infratemporal Fossa Approach Fallopian Bridge Technique Transcondylar Approach Complete Carotid Mobilization Results Glomus Tympanicum Tumors Glomus Jugulare Tumors Complications Glomus Tympanicum Tumors Glomus Jugulare Tumors Radiation Summary Chapter 47 47 - Rehabilitation of Lower Cranial Nerve Deficits After Neurotologic Skull Base Surgery Lower Cranial Nerve Deficits and Rehabilitation Trigeminal Nerve: Mandibular Division (Cranial Nerve V3) Rehabilitation of Lower Cranial Nerve Deficits After Neurotologic Skull Base Surgery Abducens Nerve (Cranial Nerve VI) Glossopharyngeal Nerve (Cranial Nerve IX) Vagus Nerve (Cranial Nerve X) Spinal Accessory Nerve (Cranial Nerve XI) Hypoglossal Nerve (Cranial Nerve XII) Cervical Sympathetic Chain Summary Chapter 48 48 - Middle Fossa Approach Preoperative Evaluation Middle Fossa Approach Patient Counseling Surgery Preoperative Preparation Surgical Anatomy Surgical Technique Results Course of Healing Success Rate Complications Patient Selection Pitfalls Summary Chapter 49 49 - Translabyrinthine Approach Patient Selection Surgical Procedure Management of the Contracted Mastoid Postoperative Care Complications Facial Nerve Bleeding Cerebrospinal Fluid Leak Meningitis Results Postoperative Follow-Up Summary Editorial Comment Neurosurgical Techniques in Acoustic Tumor Surgery Removal of Small Acoustic Tumor Removal of Large Acoustic Neuroma Chapter 50 50 - Retrosigmoid Approach to Tumors of the Cerebellopontine Angle Surgical Anatomy Preoperative Evaluation and Patient Counseling Patient Selection Hearing Preservation Use of Retrosigmoid Approach in Combined Therapy of Vestibular Schwannoma Vestibular Schwannoma in a Patient with Chronic Otitis Media Tumors Extending into the Inferior Portion of Cerebellopontine Angle Tumors with Limited Extension into Meckel’S Cave Revision Surgery Relative Contraindications Deep Extension into Internal Auditory Canal Extension into the Cranial Base Large Tumors Patient Preparation and Positioning Surgical Site Preparation Special Instruments Surgical Technique Craniectomy Exposure of Cerebellopontine Angle Exposure of Internal Auditory Canal Vestibular Schwannoma Resection Hemostasis Internal Auditory Canal Closure Craniotomy Closure Dressing Postoperative Care Results Complications Vascular Complications Hemorrhage Anterior Inferior Cerebellar Artery Syndrome Nonvascular Complications Complications from Patient Positioning Cerebrospinal Fluid Leakage Aseptic and Bacterial Meningitis Hydrocephalus Cerebellar Dysfunction Persistent Headache Residual or Recurrent Tumor Chapter 51 51 - Transotic Approach Acoustic Neuroma Preoperative Evaluation Surgical Technique Preoperative Preparation Surgical Site Preparation, Positioning, and Draping Transotic Approach Intraoperative Monitoring and Concerns Skin Incision Blind Sac Closure of External Auditory Canal Creation of the Mastoid Cortical Bone Flap Subtotal Petrosectomy: Exposure of Jugular Bulb and Petrous Carotid Obliteration of Eustachian Tube Exenteration of Otic Capsule Unroofing of Labyrinthine Portion of Facial Nerve Tumor Removal Wound Closure Dressing and Postoperative Care Tips and Pitfalls Results Complications and Management Alternative Techniques Chapter 52 52 - Transcochlear Approach to Cerebellopontine Angle Lesions Transcochlear Approach: Advantages Transcochlear Approach: Disadvantages Patient Evaluation and Preoperative Counseling Surgical Anatomy Surgical Technique Overview Setup Incision Mastoidectomy Closure of External Auditory Canal Labyrinthectomy and Skeletonization of Internal Auditory Canal Facial Nerve Rerouting Transcochlear Drill-Out Tumor Removal Closure Postoperative Care Results Complications and Management Summary Chapter 53 53 - Extended Middle Cranial Fossa Approach Surgical Anatomy Surgical Technique Extended Middle Cranial Fossa Approach Limitations Advantages Conclusion Chapter 54 54 - Anterior and Subtemporal Approaches to the Infratemporal Fossa Patient Selection Preoperative Evaluation Diagnostic and Staging Work-Up Rehabilitation Considerations Reconstructive Considerations Other Perioperative Considerations Surgical Approaches Preauricular (Subtemporal) Approach Postauricular (Transtemporal) Approach Lateral Fisch Infratemporal Fossa Approaches Fisch Type B Fisch Type C Fisch Type D Anterior Transfacial Approach (Facial Translocation) Transorbital Approach Postoperative Care Pitfalls and Complications Chapter 55 55 - Endoscopic Endonasal Approaches to the Skull Base and Paranasal Sinuses Introduction and Background Basic Endoscopic Endonasal Concepts Expanded Endonasal Approaches: Anatomical Modules Sagittal Plane Transfrontal Approach Transcribriform Approach Transplanum-Transtuberculum Approach Transsellar Approach Transclival Approaches Superior Clivus Middle Clivus Lower Clivus (Foramen Magnum) Transodontoid Approach Coronal Plane: Anterior Fossa Supraorbital Approach Transorbital Approach Transpterygoid Approaches Zone I (Petrous Apex). Lesions of the petrous apex may be approached medially through the sphenoid sinus. Cholesterol granuloma ... Zone II (Petroclival Junction). As an extension of the petrous apex approach, this zone is involved with similar tumors. In addi... Zone III (Quadrangular Space or Meckel’s Cave). The cranial nerves that are contained in the cavernous sinus are crowded into it... Zone IV (Superior Lateral Cavernous Sinus). There are few indications for surgically addressing tumors in the superior lateral c... Zone V (Infratemporal Fossa). Lesions that affect the medial aspect of the temporal fossa are usually extensions of tumors such ... Posterior Fossa Transcondylar Approach Lower Infratemporal Fossa-Parapharyngeal Space Complications and Learning Curve Reconstruction Outcomes Future Directions Conclusions Chapter 56 56 - Petrosal Approach Preoperative Evaluation Petrosal Approach Preoperative Preparation Surgical Techniques Posterior Exposure Middle Fossa Exposure Closure Results Future Directions Summary Chapter 57 57 - Neurofibromatosis 2 Introduction Neurofibromatosis 2 Differentiated from Neurofibromatosis 1 Clinical Characteristics of Neurofibromatosis 2 Definition Prevalence and Incidence of Neurofibromatosis 2 Imaging Studies for Neurofibromatosis 2 Molecular Genetics of Neurofibromatosis 2 Family History of Neurofibromatosis 2 Screening for Neurofibromatosis 2 Schwannoma Tumor Types Intracranial Schwannomas Hearing Changes in Patients with Vestibular Schwannomas Meningiomas Spinal Tumors Eye Findings Skin Tumors Treatment Options for Vestibular Schwannomas in Neurofibromatosis 2 Hearing Preservation in Neurofibromatosis 2 Observation without Surgical Intervention for Neurofibromatosis 2 Retrosigmoid Craniotomy with Partial Removal Non-Hearing Preservation for Neurofibromatosis 2 Auditory Brainstem Implant for Neurofibromatosis 2 Cochlear Implants in Neurofibromatosis 2 Stereotactic Irradiation for Neurofibromatosis 2 Drug Therapy for Neurofibromatosis 2 Management of Neurofibromatosis 2 Cranial Tumor Detection and Staging Neurological Examination of Neurofibromatosis 2 Patients Spinal Tumor Detection in Neurofibromatosis 2 Neuro-Ophthalmological Examination Summary of Testing for Neurofibromatosis 2 Patients Genetic Testing for Neurofibromatosis 2 Summary Chapter 58 58 - Auditory Implants for the Central Nervous System Auditory Implants for the Central Nervous System Device Penetrating Electrode Auditory Brainstem Implant Anatomical Considerations Surgical Considerations Implantation Technique Postoperative Care Postoperative Complications Results Auditory Midbrain Implants (AMI and Inferior Colliculus Implant) Summary Chapter 59 59 - Extreme Lateral Infrajugular Transcondylar Approach for Resection of Skull Base Tumors Surgical Procedure Complications Results Discussion Chapter 60 60 - Management of Postoperative Cerebrospinal Fluid Leak Technique Lumbar Drain Technique Management of Postoperative Cerebrospinal Fluid Leak Wound Exploration and Reclosure Refractory Cerebrospinal Fluid Leaks Technique Ear Canal Closure with Eustachian Tube and Middle Ear Obliteration Middle Fossa Obliteration of the Eustachian Tube Transnasal Endoscopic Medial Eustachian Tube Obliteration Recent Strategies to Improve Upon Cerebrospinal Fluid Leak Rate Summary Chapter 61 61 - Care of the Eye in Facial Paralysis and Facial Reanimation Techniques Preoperative Clinical Evaluation Methods of Determining the Extent and Prognosis of Facial Nerve Paralysis Nonsurgical Interventions Surgical Indications Day of Surgery Preoperative Evaluation Preparation in the Operating Room for Periocular Interventions Positioning Local Injections Surgical Site Preparation Surgical Site Draping Postoperative Care to the Periocular Area Upper Eyelid Surgery Lid-Loading Procedures Surgical Technique Levator Palpebrae Superioris Lengthening Palpebral Springs Surgical Technique Silicone Rods Tarsorrhaphy Surgical Technique Blepharoplasty and Brow Lift Lower Eyelid Procedures Horizontal Lid-Shortening Techniques Canthoplasty Surgical Technique Spacers Static Slings Midface Lift Neuromuscular Modifications: Dynamic Reanimation Surgical Technique Interposition Grafting Regional Muscle Transfer Temporalis Muscle Transfer: Standard Technique Surgical Technique Postoperative Care and Complications Orthodromic Temporalis Tendon Transfer Surgical Technique Postoperative Care and Complications Nerve Transpositions Surgical Technique Direct Cross Facial Nerve Graft Free-Tissue Transfer Ancillary Procedures Postoperative Synkinesis and Asymmetry Neurotoxins Physical Therapy Lower Lip Interventions Surgical Technique Considerations During the Long-Term Postoperative Period Conclusions Chapter 62 62 - Hypoglossal Facial Anastomosis Hypoglossal Facial Anastomosis Surgical Technique Nerve Growth Factors and Conduits Newer Modifications of Hypoglossal Facial Anastomosis End-to-Side Anastomosis via Translocation of Facial Nerve from the Fallopian Canal Results Summary Chapter 63 63 - Intraoperative Neurophysiological Monitoring History Indications Physiology Electromyography Intraoperative Neurophysiological Monitoring Stimulation Burst Activity Trains Anesthetic Issues Practical Applications in Surgery Locating the Facial Nerve Avoiding Trauma Postoperative Prognosis and Prognosis of Acute Injury Transcranial Motor-Evoked Potentials Artifactual Responses Troubleshooting the Facial Nerve Monitor Antidromic Facial Nerve Monitoring Monitoring Hearing Pathophysiology Preoperative Testing Indications General Considerations Auditory Evoked Brainstem Response Interpretation of Results Electrocochleography Interpretation of Results Direct Eighth Cranial Nerve Recording Interpretation of Results Otoacoustic Emissions Laser Doppler Cochlear Blood Flow Monitoring Other Cranial Nerves Conclusion Chapter 64 64 - Stereotactic Radiosurgery of Skull Base Tumors Stereotactic Radiosurgery of Skull Base Tumors Preoperative Counseling Surgical Technique The Gamma Knife Unit Frame Attachment Imaging Treatment Planning Treatment Gamma Knife Surgery Outcomes Hearing and Balance Function Tumor Control and Microsurgical Outcomes After Gamma Knife Surgery Alternative Stereotactic Radiosurgery Technologies Cyberknife Stereotactic Radiology Overview of Treatment Planning Dose Distribution Localization Treatment Delivery Alternative Applications Summary Chapter 65 65 - Vascular Considerations in Neurotologic Surgery Introduction Internal Carotid Artery External Carotid Artery Cerebellar Arteries Venous Sinuses Overview of the Transpetrosal Approach Presigmoid Translabyrinthine Transcochlear and Transotic Anterior Transpetrosal Transpetrous or Kawase’s Approach Petrous Internal Carotid Artery Exposure Presentation Pathophysiology Management Treatment High Internal Carotid Artery Aneurysms Vertebrobasilar Aneurysms Dural Arteriovenous Fistulas (Transverse-Sigmoid and Tentorial Fistulas) Transverse-Sigmoid Fistulas Tentorial Fistulas Cavernous Malformations Preoperative Embolization Glomus Tumors Hemangioblastomas Hemangiomas Cerebral Revascularization and Bonnet Bypass Conclusion