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IAC 360°

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IAC 360°

  1. 1. IAC 360° 15-12-2015 12.43pm
  2. 2. Great teachers – All this is their work . I am just the reader of their books . Prof. Paolo castelnuovo Prof. Aldo Stamm Prof. Mario Sanna Prof. Magnan
  3. 3. For Other powerpoint presentatioins of “ Skull base 360° ” I will update continuosly with date tag at the end as I am getting more & more information click www.skullbase360.in - you have to login to slideshare.net with Facebook account for downloading.
  4. 4. Bottle neck concept – junction of labyrinthine & internal auditory canal facial nerve is narrow [ bottle neck ]
  5. 5. From CP angle book – see other photos – fig 9
  6. 6. From mario sanna paraganglioma book Degree of bone removal required in various approaches. POST., posterior; ANT., anterior; F, facial nerve.
  7. 7. FN & SVN converge as they pass toward the fundus , while the CN & IVN can be seen diverging from each other as they pass laterally to the fundus - --- Basal turn of cochlea pushing away IVN from CN See the cochlea in below photo
  8. 8. 7up- 7th is above Coca cola – cochlear n. is cola[=lower]
  9. 9. Translabyrinthine Transpetrous ( = Transapical )
  10. 10. The Enlarged Translabyrinthine Approach with Transpetrous ( = Transapical ) Extension Schematic drawings showing the amount of bone removal around the internal auditory canal in the different variants of the translabyrinthine approach. Note that in the transapical modification the exposure is 320° and about 360° in types I and II, respectively. Abbreviations as in Fig. 5.1. cn, cranial nerve; CN, cochlear nerve; FN, facial nerve; IV, inferior vestibular nerve; SV, superior vestibular nerve.
  11. 11. (Right ear) Diagram of the internal auditory canal near the fundus. The superior ampullary nerve (AN) is shown overlapping the superior vestibular nerve (SVN). CN, cochlear nerve; FN, facial nerve; HC, horizontal crest; IVN, inferior vestibular nerve; VC, vertical crest (Bill’s bar).
  12. 12. identify the superior ampullary nerve first and then find the facial nerve (F) after eliminating this nerve and the superior vestibular nerve (Vs).
  13. 13. Drilling inferior to the right internal auditory canal (IAC). Further extensive drilling inferior to the internal auditory canal (IAC) toward the petrous apex.
  14. 14. Extensive bone removal inferior and superior to the internal auditory canal (IAC). Bone superior to the canal (*) is still to be removed. The whole contents of the internal auditory canal (IAC) are pushed inferiorly to allow removal of the remaining bone (*) superior to the canal.
  15. 15. The whole contents of the canal are displaced inferiorly to show the extent of bone removal. The anterior wall of the canal can also be drilled if needed. Schematic drawing showing the technique and extent of bone removal in the type I (green line) and type II (red line) transapical extension. F, facial nerve; C, cochlear nerve; Vs, superior vestibular nerve; Vi, inferior vestibular nerve.
  16. 16. Schematic drawing showing the technique and extent of bone removal in the type I (green line) and type II (red line) transapical extension. F, facial nerve; C, cochlear nerve; Vs, superior vestibular nerve; Vi, inferior vestibular nerve.
  17. 17. General view of the structures in the cerebellopontine angle after opening the dura. Note the enhanced exposure of the angle and the excellent exposure of the trigeminal nerve (V). The trigeminal nerve (V) is pushed superiorly. The basilar artery (BA) in the prepontine cistern can be seen well.
  18. 18. With more traction of the tentorium, a panoramic view of the structures in the angle is available. The trochlear nerve (IV) is seen before piercing the tentorium to gain access to the middle fossa.
  19. 19. (Left ear) Cadaveric dissection showing the intra- canalicular structures. Note the AICA runs between the facial nerve and the cochlear nerve in this case. FN(m), mastoid segment of the facial nerve; JB, jugular bulb; SS, sigmoid sinus; MFD, middle fossa dura; AICA, anterior inferior cerebellar artery; CN, cochlear nerve; FN, intracanalicular facial nerve; *, the anterior wall of the internal auditory canal. (Left ear) Superior surgical field of enlarged translabyrinthine approach to the CPA. The trochlear nerve (IV); trigeminal nerve (V) and superior cerebellar artery (SCA) can be observed. AICA, anterior inferior cerebellar artery; FN, facial nerve; FN(m), mastoid segment of the facial nerve; JB, jugular bulb; SS, sigmoid sinus.
  20. 20. Mohnish grover Cochlear implant radiology lines
  21. 21. Middle cranial fossa approach
  22. 22. For Other powerpoint presentatioins of “ Skull base 360° ” I will update continuosly with date tag at the end as I am getting more & more information click www.skullbase360.in - you have to login to slideshare.net with Facebook account for downloading.

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