This is a demonstration of the retrosigmoid approach for microsurgical resection of a cerebellopontine angle tumor. Th patient presented with gait disturbance and normal hearing. A suboccipital craniotomy was used for access to the cerebellopontine angle. Using microsurgical technique, the tumor was dissected away from the glossopharyngeal nerve. Pathological analysis confirmed that the tumor was a schwannoma of the glossopharyngeal nerve.
Contributors: Daniel Felbaum and H. Jeff Kim
The video demonstrates the resection of a trigeminal schwannoma via a middle fossa craniiotomy and anterior petrosectomy. A large dumbbell-shaped tumor was essentially two tumors in one. The anterior petrosectomy provided access mainly to the posterior component of the tumor, which was compressing the pons, and obscured by the tentorium and petrous ridge. Mobilization of the lateral wall of the cavernous sinus freed the anterior component and thus allowed the removal of the rest of the schwannoma.
Contributor: Gresham T. Richter, MD (Arkansas Children’s Hospital)
Pressure equalization tube placement is one of the most common procedures in the pediatric population. This video demonstrates the surgeon’s view of the right ear through the operative microscope.
Indications: recurrent otitis media with effusion, chronic otitis media with effusion (>3 months duration), speech/language delay secondary to otitis. Instruments: operative microscope, ear speculum, ear curette, myringotomy knife, suction tube, pressure equalization tube
1. Speculum inserted into external auditory canal
2. Cerumen removed with the curette (not shown in video)
3. Myringotomy performed on anterior-inferior quadrant of tympanic membrane
4. Fluid aspirated with suction tube
5. Pressure equalization tube (PET) inserted and secured
6. Antibiotic otic drops applied
7. Cotton dressing applied
Recommended Resource: Lambert E, Roy S. Otitis media and ear tubes. Pediatric Clinics of North America. 2013;60(4):809-26. Available at: http://www.ncbi.nlm.nih.gov/pubmed/23905821
The authors have no conflicts of interest or financial disclosures.
Contributors: H. Jeffrey Kim
The translabyrinthine approach has often been reserved for large acoustic neuromas because it requires less retraction on the cerebellum when compared to the retrosigmoid approach for a similar tumor. However, the translabyrinthine approach is equally useful for smaller tumors, when the patients has no residual ipsilateral hearing. It allows for early visualization of the facial nerve, and thus better protection of this crucial nerve.
DOI #: http://dx.doi.org/10.17797/168b12z8m4
Contributors: Daniel R. Felbaum
Microvascular decompression is the most effective surgical procedure for treating trigeminal neuralgia in patients with classic symptoms. The most frequent compressive force is the superior cerebellar artery. Here we demonstrate the procedure in a patient with long-standing, classic symptoms of trigeminal neuralgia, in whom we discovered compression from venous structures.
Endoscopic posterior cricoid split with rib grafting can be used in children with Bilateral Vocal Fold Immobility due to bilateral vocal fold paralysis or cricoarytenoid joint fixation with posterior glottic stenosis. It is preferred to open laryngotracheal reconstruction because it does not disrupt the anteior cricoid ring therby preserving the “spring” of the cricoid.
Endoscopic posterior cricoid split with rib grafting can be used in children with bilateral vocal fold immobility due to bilateral vocal fold paralysis or cricoarytenoid joint fixation with posterior glottic stenosis. It is preferred to vocal cordotomy/arytenoidectomy because it is a non-destructive procedure with no impact on voice and swallowing. It is also preferred to open laryngotracheal reconstruction because it does not disrupt the anterior cricoid ring thereby preserving the “spring” of the cricoid.