pacificright.blogg.se - Internal auditory canal mri anatomy

#Internal auditory canal mri anatomy generator#
#Internal auditory canal mri anatomy skin#

Elevate the dura along the floor of the middle cranial fossa from posterior to anterior so as not to disrupt the greater superficial petrosal nerve (GSPN).Place Oxycel cigars under the bone flap anteriorly, posteriorly, and superiorly.Circumferentially elevate the dura from the overlying cranium, using the bipolar cautery liberally to stop bleeding from the dura.Check exposure: if the bone window is not flush with the tegmen, remove excess bone with rongeur or drill.Elevate bone flap off of dural with Joker elevator.Mark bone flap to ensure easy and properly oriented replacement at end of case.Branches of the middle meningeal artery will be encountered, which are controlled with bone wax or bipolar cautery.Use diamond 4 mm burr, to remove the final layer of bone over the dura.Use a 4 mm (BJG) or 5 mm (MRH) cutting burr to remove the majority of the bone.Hyperventilate patient to end tidal CO2 of 30.Have anesthesiologist administer 0.4 grams/kg of mannitol now.Should be able to see zygomatic root easily after elevation.

#Internal auditory canal mri anatomy skin#

Inferiorly-based temporalis flap if anterior-based skin flap.

Anterior temporalis flap if posterior-based skin flap.

leave cuff of fascia on either side of muscle flap.

Harvest a large piece of temporalis fascia prior to elevation of the muscle flap.

Keep temporoparietal fascia layer attached to scalp during skin flap elevation.

Temporalis muscle flap is then reflected anteriorly.

Incision starts just behind temporal hairline and a rounded box shape approx 6 cm wide is carried back approximately 6-7 cm.

Temporalis muscle is then reflected inferiorly.

Good for extended middle fossa approaches.

Incision starts anterior to tragus, extends posteriorly approximately 3-4 cm posterior to pinna, superiorly 5-6 cm, and anteriorly again to the temporal hairline.Anterior/inferiorly-based skin flap (MH).Also note the posteriorly based temporal skin flap design.

#Internal auditory canal mri anatomy generator#

Patient positioning with 3 point straps to allow rolling of the bed to improve operative exposureĮlectrode placement NIMS monitor electrodes in the orbicularis occuli and orbicularis oris with ground electrods on the chest ABR click generator in the operertive side ear canal 3 ABR electrodes (one on each mastoid and one on vertex). Nursing instructions to call family every 3 hours White board: intra-operative medications (1 gram Ancef Q8hrs, 10 mg Decadron q6 hrs, Mannitol at 0.4 mg/kg given after performing craniotomy). Pre-operative note, audiogram, ABR test results and Internal medicine surgical co-management note placed on wall Patient images Stenver view mastoid to assess bone thickness overlying superior canal MRI coronal and axial (post-contrast) showing tumor and confirming operative side.