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transmastoid translabyrinthine approach for removal of vestibular neuroma

MADDIE

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Would appreciate any help with this surgery. Patient is post- labyrinthectomy neuroma.


Postauricular incision with dissection down to the margins of the mastoid bowl. Mastoid filled with regenerated bone. This was drilled and it was noted that there was a mastoid defect with soft tissue obliterating it. It was further noted that this was temporal lobe and removed. This allowed drilling to proceed deep toward the vestibule and the internal auditory canal. As the drilling proceeded medially, part of the labyrinth that is the superior canal and part of the bony canal were exposed and filled with fibrous tissue which consisted of the neuroma tissue that had been regenerated from the vestibular nerve. this was all cleaned out.. Because the dense bone surrounding this area was so difficult to remove and since we did remove the amputated neuroma, it was felt that drilling further to expose the internal auditory canal was not the preferred choice. A small defect in the posterior fossa dura was made to identily the structures entering the sleeve that fills the subarcuate mastoid canal. DuraSeal was used to close the dural defect and also to cover the area where the temporal lobe herniation had been localized and removed. Aslo adipose tissue ( previously obtained from the abdomen) was placed in the area where the Dura Seal had been placed and then filling the mastoid cavity up to the level of the cortex. Skin margins were approximated with chromics to the deep surfaces and staples to the skin.
 
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