E-Book, Englisch, 704 Seiten, ePub
ISBN: 978-3-13-258156-2
Verlag: Thieme
Format: EPUB
Kopierschutz: Wasserzeichen (»Systemvoraussetzungen)
Each chapter of the text discusses a specific procedure and is divided into two sections, covering both the general surgical steps of the procedure and also its application. Within each chapter you'll find: general considerations; surgical techniques; applications; tips and pratfalls; imaging scans of illustrative cases; and color plates of pre- and post-operative preparation and instrumentation. The final two chapters discuss anesthesia issues and the impact of neuroradiology on skull base surgery. All of the cases used in the book reflect actual procedures, not hypothetical situations.
All neurosurgeons and otolaryngologists involved in skull base surgery will benefit from having this classic text in their professional library. It demonstrates the procedures that have proven to be both safe and reliable through the years.
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Weitere Infos & Material
Chapter 1 Subtotal Petrosectomy
Part 1 General Considerations
Part 2 Surgical Technique
Part 3 Applications
Part 4 Tips and Pitfalls
Part 5 Imaging of Illustrative Cases
Part 6 Color Plates
Chapter 2 Transotic Approach to the Cerebellopontine Angle
Part 1 General Considerations
Part 2 Surgical Technique
Part 3 Applications
Part 4 Tips and Pitfalls
Part 5 Imaging of Illustrative Cases
Part 6 Color Plates
Chapter 3 Infratemporal Fossa Approach Type A
Part 1 General Considerations
Part 2 Surgical Technique
Part 3 Applications and Adjunctive Procedures
Part 4 Tips and Pitfalls
Part 5 Imaging of Illustrative Cases
Part 6 Color Plates
Chapter 4 Infratemporal Fossa Approach Type B
Part 1 General Considerations
Part 2 Surgical Anatomy
Part 3 Surgical Technique
Part 4 Applications
Part 5 Tips and Pitfalls
Part 6 Imaging of Illustrative Cases
Part 7 Color Plates
Chapter 5 Infratemporal Fossa Approach Type C
Part 1 General Considerations
Part 2 Surgical Anatomy
Part 3 Surgical Technique
Part 4 Applications
Part 5 Tips and Pitfalls
Part 6 Imaging of Illustrative Cases
Part 7 Color Plates
Chapter 6 Transtemporal Supralabyrinthine Approach
Part 1 General Considerations
Part 2 Surgical Anatomy
Part 3 Surgical Technique
Part 4 Applications
Part 5 Tips and Pitfalls
Part 6 Imaging of Illustrative Cases
Part 7 Color Plates
Chapter 7 Translabyrinthine Approach
Part 1 General Considerations
Part 2 Surgical Technique
Part 3 Applications and Adjunctive Procedures
Part 4 Tips and Pitfalls
Part 5 Imaging of Illustrative Cases
Part 6 Color Plates
Chapter 8 Petrosectomy and Radical Dissection of Retromandibular Fossa
Part 1 General Considerations
Part 2 Surgical Anatomy
Part 3 Surgical Technique
Part 4 Tips and Pitfalls
Part 5 Imaging of Illustrative Cases
Part 6 Color Plates
Chapter 9 Anesthesia for Surgery of the Skull Base
Chapter 10 Interventional Neuroradiology of Skull Base Tumors
Preface In ancient atlases some unexplored lands are marked “hic sunt leones”. Few dare to explore a surgical terra incognita, but the danger lies not in removing disease but in leaving it there. Charles A. Ballance The source of this atlas is the experience gained with 1500 skull base operations performed at the ENT Department of the University Hospital in Zurich from 1967 to 1985. Each chapter refers to a particular surgical approach and is divided in two parts; one demonstrating the general surgical steps of each procedure, the other its applications. The applications relate to individual rather than ideal cases to keep in pace with the uniqueness of surgical experience. Trifles make perfection and what happens before and after surgery is as important as the operation itself. Therefore, at the beginning of each chapter there is a detailed account of pre- and postoperative care, preparation and instrumentation as well as a short review of indications and contraindications. A section on Tips and Pitfalls at the end of each chapter recapitulates the experience gained with the corresponding surgical procedure. A collection of pre- and postoperative roentgenograms and MRI scans of illustrative cases and “color operative photographs”conclude each chapter. Although the management of the facial nerve is a main concern throughout this book no attempt was made to concentrate the related procedures under one heading. This would have detracted from the scope of this atlas. The technical requirements for microsurgery of the skull base may appear formidable. This applies, however, to all new surgical procedures. Charles Ballance writes in his famous book on “Surgery of the Temporal Bone”: “but difficult as the operation is, there is no justification for throwing around it a cloak of mystery as if only the elect were ever called upon to perform it”. This atlas is not an attempt to popularize skull base surgery. Its aim is to show the details of each surgical procedure so that the interested surgeon may perform it with more ease than we had in its development. Microsurgery of the skull base is not a superspecialized surgical exercise. My professional formation was determined by three great teachers: Luzius Rüedi, John Conley and William House. Luzi transmitted the secrets of microsurgery of the ear and his passion for the essential, John the drive to overcome with rational elegance the most arduous surgical challenges of the head and neck, and Bill the determination of a pioneer looking for new surgical fields beyond the temporal bone. It was by combining the different teachings and not by superspecializing in one that I found the adequate technical background for the work at the skull base. The desire to include the skull base into the horizon of otologic surgery originated during a six weeks visit in Los Angeles in 1967. Fascinated by William House’s innovative work and after intensive training on the cadaver, I performed the first translabyrinthine and middle fossa approaches in Zurich together with Gazi M. Yasargil at the end of that year. It has been a great privilege to be introduced into neurosurgical technique and philosophy through Gazi’s superb microsurgical skills and through his supercritical, demanding mind. Our direct association in the operating theatre lasted for two years; the time required for each of us to learn what was needed to carry out independent but complementary work. The approaches presented in this atlas emerged in the following years from the search for adequate ways to remove lesions situated in what was still a bony noman’s land between otology and neurosurgery. The leading principle through this evolution was to find adequate access by removing bone from the skull base rather than by elevating or retracting dura. First we modified the middle fossa approach. The temporal lobe elevation was minimized using the blue-lined superior semicircular canal as the only landmark for the internal auditory canal. The surgical access was mainly obtained by removing bone at the roof of the temporal bone, above the inner ear and was, therefore, called transtemporal, supralabyrinthine. Next was the introduction of subtotal petrosectomy. This operation, consisting of closing off the eustachian tube and exenterating all pneumatic spaces of the temporal bone, was used for the removal of various intratemporal lesions. When combined with the obliteration of the middle ear cleft and the removal of the otic capsule, subtotal petrosectomy allows removal of tumors within the posterior fossa through the complete medial wall of the temporal bone. This transotic approach has replaced the translabyrinthine route for the resection of acoustic neurinomas because it has virtually eliminated the risk of a postoperative CSF leak. Our attention then turned to the jugular foramen. Radical removal of large tumors situated in this anatomical region was precluded by the position of the fallopian canal. The solution to this surgical problem was found in the permanent anterior displacement of the facial nerve. This originated the infratemporal fossa approach type A which provides access along the intratemporal course of the internal carotid artery. The infratemporal approaches B and C were the logical sequence in striving for anterior exposure of the lateral skull base. In combination with conventional head and neck procedures they permit en bloc removal of tumors invading the skull base from the nasopharynx and parapharyngeal space. The various techniques for petrosectomy and radical dissection of the retromandibular fossa were finally developed mainly to deal with tumors of the deep lobe of the parotid gland involving the petrous bone. The co-author of this atlas, Douglas Mattox, joined in the preparation of these pages while spending a year of clinical fellowship with us in 1985. The material for this book was already collected but still needed to be put into proper form. Many weeks of common discussion, writing and re-writing were necessary to achieve this major task. They were for me a most rewarding experience. Douglas’s incredible working capacity, organization and critical compliance have greatly improved the quality and considerably shortened the time of gestation of our common endeavour. The association with Douglas has also closed a circle that initiated 27 years ago when I began my ENT career with a clinical fellowship at the John’s Hopkins hospital! The recent progress made in imaging and interventional neuroradiology has greatly influenced the surgical procedures described in this atlas. The introduction of computerized tomography in our hospital in 1975 has led to precise information on the extent of invasion and of resection of a skull base lesion. But even the most modem technology remains only as good as the people who use it. We were fortunate to meet Anton Valavanis who is an exceptionally capable, inventive and industrious neuroradiologist. He has dedicated much of his energy and time to skull base problems. The imaging of illustrative cases found at the end of each chapter is based on his splendid work. I am also grateful to Anton for agreeing to write a chapter of this atlas on interventional neuroradiology. He is a master in embolizing the finest arteries and has an unmatched skill in testing the effectiveness of collateral cerebral circulation and in occluding the internal carotid artery with detachable balloons. His work has opened new vistas for the extension of skull base surgery in the region of the cavernous sinus. Ulrich Aeppli carried out with uncommon proficiency and reliability the general anesthesia in the majority of the operations described in this book. A man of few words, it was not easy to motivate him to put his valuable experience in writing. He did it reluctantly but with great care. I am very grateful for his efforts. This atlas reflects a subjective view of skull base surgery. The procedures shown are those that we have found adequate, reliable and safe through the years. As they cover in great part a new surgical field, a step by step presentation was preferred to a display of general surgical principles. The illustrations are a selection of drawings that I have carried out personally at the end of each operation over a period of eight years. They were made by memory and entail, therefore, simplifications and deformations of reality. The final artistic work was carried out by Ivan Glitsch. Our association reaches back more than 25 years. We have learned to communicate with each other by pencil lines rather than by words. He has the great merit to have added his invaluable professional, artistic touch to the essence of the surgical act. The photographic documentation of pre- and postoperative preparation and instrumentation was carried out with extreme care by Jeanpierre Rüegg. We are grateful to Judith Terjek for giving her best in reproducing our collection of imaging slides, and for helping in selecting the microphotographs for the color plates. Many other individuals have helped directly and indirectly during the preparation of this book. A number of clinical fellows came to Zurich through the years to be introduced to microsurgery of the skull base. Their stimulating participation in surgery as well as their help in reviewing clinical histories and in the research laboratory have speeded up the cristallization of the material put in these pages. Among those I would like to mention: Derald Oldring, Robert Dufour, Julian Nedzelski, Michel...
