[Translabyrinthine approach in the surgery of acoustic neurinoma. How to shorten the operative time].
A procedure was sought for shortening duration of operation through an enlarged translabyrinthine (ETL) approach in acoustic neurinoma surgery. Two factors appear to be of primary importance. First, the equipment used must be adapted for the purpose and of reliable quality: the 3 M craniotome for the extralabyrinthine phase, the Zimmer AMSCO ototome for the labyrinthine phase, and Yasargil's autostatic retractor to maintain retraction of the temporal lobe and lateral sinuses. Second, a precise operative methodology: wide exposure and retraction of the temporal lobe and lateral sinus in all cases to provide a panoramic view of the labyrinthine region; ablation of the incus and initiation of a posterior tympanotomy to assist dissection to expose the 2nd and 3rd portions of the facial nerve; labyrinthectomy and identification of the internal auditory canal (IAC) in the region of the small fossa of the hemisphere as an aid to continuation of the operation; identification of Limaçon's aqueduct, which is a barrier that must not be crossed when exposing the jugular bulb and mixed nerve regions; isolation of the facial nerve in the base of the IAC by reclining the superior restibular nerve, the facial nerve lying just behind the latter.
D007758:Ear, Inner; D006801:Humans; D008722:Methods; D009464:Neuroma, Acoustic / Q000601:surgery*; D013997:Time Factors
La voie trans-labyrinthique dans la chirurgie du neurinome de l'acoustique. Comment raccourcir le temps opératoire.