Adult & Pediatric Spine

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1 Preauricular scalp incision. The anterior limb of the incision extends forward, at least to the hairline. 14 Lateral Skull Base Surgery: The House Clinic Atlas Extensive subgaleal elevation of the scalp is required to obtain adequate anterior exposure. Ideally, elevation is carried into the interfascial plane of the two-layer temporalis fascia. It is critical to maintain a plane deep to the fat pad that is consistently seen in this area to avoid injury of the temporal branch of the facial nerve.

4 The tympanomeatal flap is left attached to the superior bony canal and umbo, allowing a view into the hypotympanum. Fig. 5 A tympanomeatal flap is elevated with incision at the 2 and 10 o’clock positions. Pitfalls Familiarity with the anatomy of the hypotympanum is essential to prevent injury to vital structures in a relatively confined space. Treatments of injuries to the jugular bulb are detailed in the previous section on the infralabyrinthine approach. Unlike inadvertent injury to the semicircular canals, violation of the cochlea has a much higher risk of hearing loss.

VII Tumor, superior vestibular n. Vestibule Fig. 6 Critical microanatomical landmarks. 0 mm can be safely used to remove the bone of the lateral IAC. artery can be saucerized, exposing its anterior surface. Next the bone in the “post­ meatal triangle” can be removed exposing the posterior surface of the IAC. Medially, 270 degrees of bone can be removed from its circumference (Fig. 7). The circumference of the IAC is less exposed laterally because of the location of the inner ear. The lateral end of the IAC is dissected with clear identification of the labyrinthine segment of the facial nerve, Bill’s bar, and the superior vestibular nerve.

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