By MD S.James Zinreich, Donlin M. Long, John K. Niparko, Bert W. O'Malley Jr, S. James Zinrich, Daniel J. Lee

Operative tactics without delay at the base of the mind, internal ear, and cranial nerves are inherently gentle undertakings, and are extra complex through the trouble of accomplishing quick access to this restrained house. that includes large diagrams, illustrations, and pictures, this ebook comprehensively covers the entire imperative surgical techniques to the bottom of the cranium. Written by way of pioneers operating at one of many world's top facilities for complicated neurosurgery, it essentially describes the stairs in which all the key anatomical buildings on the cranium base and internal ear can be accessed with a view to practice complicated surgical interventions.

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The bicoronal incision is placed posterior to the hairline to maintain cosmesis and to allow at least Page 25 Figure 7 Drawing of a scalp flap with pericranium attached and vascular pedicle preserved 10 cm of length for a pericranial tissue flap, should it be needed. Extending the incision to the preauricular crease allows full rotation of the scalp flap inferiorly and provides increased exposure of the superior orbital rims and nasion region. The coronal scalp flap is raised at the level of the frontal bone and the pericranium and loose connective tissue remain attached until the time of reconstruction.

The use of vascular imaging modalities may also be important for tumors that are vascular in origin or that abut or invade the internal carotid artery and cavernous sinus. A more detailed discussion of pre-operative imaging and cerebral blood flow studies is included in Chapter 2. Table 1 Regions accessible by the transfacial approach Infratemporal fossa Nasopharynx Pterygopalatine fossa Clivus Cavernous sinus Medial orbit, orbital apex and fissures Anterolateral middle fossa Upper cervical spine Page 33 Figure 1 Tumor arising in the posterior maxillary sinus and invading through the infratemporal fossa to the middle cranial fossa.

Orbital soft tissue dissection is performed in the subperiosteal or subperiorbital plane to provide bony exposure, while protecting and avoiding injury to extraocular muscles and nerves, globe, and optic nerve and Page 41 Figure 9 (a) Solid lines surrounding the shaded section indicate the placement of osteotomies to mobilize the zygomaticomaxillary complex. The dotted line at the junction of the maxilla and zygoma represents an optional osteotomy to limit the extent of bony complex mobilization or resection; (b) lateral view of standard osteotomies (dotted lines) Page 42 Figure 10 Anterior view of the bony anatomy that is exposed after removal of the zygomaticomaxillary complex vessels.

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Atlas of Skull Base Surgery (The Encyclopedia of Visual by MD S.James Zinreich, Donlin M. Long, John K. Niparko, Bert
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