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Micro Ear Surgery

Tympanoplasty:

What is a Tympanoplasty surgery?

Tympanoplasty is the Repair of Ear Drum Holes

When the eardrum is unable to heal itself, our ear specialist microsurgeons perform a microsurgery to repair ear drum holes. Over years of experience in the past, ENT surgeons tried many materials to close ear drum holes like synthetic films, paper, skin, vein, ear lobe fat, fascia (thin tissue that covers muscle) and perichondrium (thin tissue that covers around cartilage). Fascia is now recognised as the best material to repair tympanic membrane perforations.

Can the eardrum be replaced?

Ear drum can be replaced by helping it naturally to heal by placing a graft in the ear drum hole area.

Ear Drum Hole Closure Techniques

Myringoplasty means microsurgery confined to the ear drum itself. The middle ear hearing bones (ossicles) are not touched. It is most often performed for small eardrum holes. The ear drum uses the fascia graft as a scaffold over which a new eardrum can grow. Myringoplasty method is effective in small perforations of ear drum.

Tympanoplasty is commonly performed for ear drum holes greater than 10 – 20% of the size of the entire ear drum. There are different types of Tympanoplasty.

Tympanoplasty: the micro ear surgery is confined to the eardrum alone and no manipulation of the middle ear hearing bones is done. Tympanoplasty which includes manipulation of the middle ear hearing bones is called tympanoossiculoplasty (Tympanoplasty with ossicular reconstruction). Surgery which includes manipulation of the mastoid bone behind the ear is called Tympanoplasty with Mastoidectomy.

Same Day Discharge:

All patients who underwent any type of tympanoplasty procedure are discharged home the same day of surgery as no rest is required unless there are complicating factors.

Success Rate:

WE at MicroCare ENT Hospital and Research institute gives you the best result possible with 100 % success rate in primary cases and overall, there is approximately 99% success rate in closing tympanic membrane perforations with tympanoplasty in secondary cases where severe complications occur as a result of previous surgeries done elsewhere. MicroCare has become one of the best ENT hospitals in the world for ear micro surgeries.

Mastoidectomy:

What Is a Mastoidectomy?

Mastoidectomy is a micro surgical procedure of the ear that removes damaged mastoid air cells which are air cells present behind your ear in your skull. The damaged mastoid air cells are often the result of an ear infection that has spread into your mastoid bone behind the ear and also because of persistence of the infection for a long time.

What are types of Mastoidectomy?

Simple Mastoidectomy: your ENT microsurgeon opens your mastoid bone, removes the infected and diseased air cells and opens drainage pathways in your middle ear.

Modified Radical Mastoidectomy: your ENT microsurgeon removes some part of your mastoid bone which is diseased and rebuilding your eardrum.

Radical Mastoidectomy: your ENT microsurgeon removes your eardrum, remove your middle ear structures and possibly place a skin graft in your middle ear. It is done in completely dead ear which is not at all useful to you.

Why do I need a Mastoidectomy?

Proper antibiotics at proper dose and duration usually treat ear infections, but surgery is an option if antibiotics fail.

The main purpose of the Mastoidectomy operation is to treat complications of chronic ear infection (chronic otitis media, COM) which is a long term ear infection in your middle ear causing serious complications like Cholesteatoma, which is a skin pouch, if left untreated, destroys everything on its way including bone. Cholesteatoma or chronic infection may in turn leas to further complications like Brain Abscess, Deafness, Facial Nerve Paralysis which causes you the facial paralysis, Meningitis also called inflammation of the membranes of your brain, Labyrinthitis or Dizziness or Vertigo.

Your ENT doctor may also perform a Mastoidectomy in a cochlear implant surgery.

This Mastoidectomy surgery can also be done to remove abnormal growths or tumours at the base of your skull.

How Is a Mastoidectomy Performed?

The Mastoidectomy is usually performed under general anaesthesia. This can be performed under local anaesthesia also. While in general anaesthesia, you are asleep and while in local anaesthesia, you can talk to our ENT Microsurgeon while doing the surgery. We use advanced equipment to get you the best result.

What are complications of Mastoidectomy operation? Complication prevention

You will be with safe hands of our expert ENT microsurgeons at MicroCare ENT Hospital and Research Institute. Thorough knowledge of temporal bone anatomy and judicious use of landmarks typically allows our surgeons to avoid complications.

You need to have regular follow-ups with your surgeon if you have cholesteatoma. Your doctor will check your operated ear to make sure that your ear is healing correctly and will remove your bandage during your follow-up visit.

Key considerations

Our Expert ENT Microsurgeons keep the mastoid surgery safe and Successful by routine identification of key anatomic landmarks and critical structures like tegmen (middle fossa floor), sigmoid sinus, external auditory canal, lateral semicircular canal and facial nerve.

A high-speed electric or pneumatic drill with various tools and attachments, the operating microscope with various magnification settings and various micro instruments specifically designed for ear micro surgery are used in conjunction with copious suction irrigation when performing mastoid surgery.

Ossiculoplasty:

Repair of chain of hearing bones (Ossicular Chain)

Ossiculoplasty is defined as the repair or reconstruction of the ossicular chain.

Why is Ossiculoplasty needed?

Ossiculoplasty is an operation often performed in conjunction with Tympanoplasty operation to repair the damaged hearing bones or ossicles. Though Tympanoplasty helps to protect the middle ear by preventing recurrent ear infections and restore the hearing capability of the patient, ideal outcome in hearing is not achieved in all patients. In those cases Ossiculoplasty helps to recover further the remaining hearing.

Ear drum holes which are present for many years usually lead to erosion of hearing bones which disrupt the chain of hearing bones of the middle ear leading to significant hearing loss. When, there is moderate to severe hearing loss about 40 db and more, it is likely that hearing bones are damaged. Then, comes the need of Ossiculoplasty.

Hearing loss from ossicular chain damage may result from either discontinuity or fixation of the ossicular chain. Discontinuity commonly occurs because of eroded joints of hearing bones in chronic ear infection. The joint commonly damaged is the joint between Incus and stapes bones. Absent incus, or stapes superstructure are also other causes. Ossicular fixation arising out of chronic infection or otosclerosis is also common.

Procedure and Types

The status of the hearing bones remnants determines which graft or implant can be used in that particular patient. Better result in hearing can be achieved when as much of the remaining functional ossicular chain as possible is used during reconstruction of hearing bones.

There are different types of ossicular reconstruction materials available. Each of these materials possesses unique properties and also unique problems when exposed to the environment of the middle ear. Complications or problems include implant extrusion, graft failure and persistent hearing loss.

The ideal prosthesis for ossicular reconstruction should be biocompatible, safe, stable, ease of configuring the prosthesis during surgery and capable of yielding optimal sound transmission.

Autologous Incus grafts maintain their contour, shape, size and physical integrity for long time and subsequently undergo new bone formation and remodelling. And thus is the best material for Ossiculoplasty. Autologous cartilage, Plasti-Pore, Hydroxylapatite, Titanium are other implants used in Ossiculoplasty. Titanium shows significant bio stability in the middle ear for long time.Hearing amplification with hearing aids is an alternative to Ossiculoplasty in patients with conductive or mixed hearing loss.

Post-operational care

Walking is a normal activity that can be started straight away after the surgery.

You can carry out your normal day to day activities

Avoid strenuous activity, do not lift anything heavier during the first postoperative week

Sneeze with your mouth open

Keep the operated ear dry. Cover your ear well while taking bath or shower with a cotton ball coated with Vaseline to protect the ear from water.

Blow your nose gently or avoid blowing nose.

You may resume your regular diet as soon as you get home.

Disclaimer

This information is not intended to replace or substitute the instructions of your doctor.

Stapedectomy:

What is Otosclerosis?

Otosclerosis is a disease of the middle ear hearing bones where excess calcification impend vibrations of sound to get transmitted into inner ear and causes hearing impairment. It sometimes affects inner ear.

Stapedial Otosclerosis

Usually otosclerosis occurs in the stapes bone which is the smallest bone in the body and is the final link in the chin of middle ear hearing bones. The stapes is in contact with the inner ear fluids through a window called Oval window. Any interference with its movement results in hearing impairment. This type of hearing impairment can usually be corrected by Stapedectomy operation.

Cochlear Otosclerosis

When otosclerosis spreads to the inner ear hearing impairment occurs as a result of interference with the nerve function. This is called sensorineural deafness and once it develops it will become permanent hearing loss. This type of nerve impairment is called cochlear otosclerosis. Sometimes it may spread to the balance canals in the inner ear and may cause giddiness also.

Who Gets Otosclerosis and Why?

It is common in middle-aged women esp. Caucasians. This condition is less common in the people of Japan and South America and is rare in African Americans.

The disease can develop in both women and men, but is particularly more common in pregnant women who often experience a rapid decrease in hearing for unknown reasons.

The hallmark symptom of otosclerosis is slowly progressive hearing loss that usually starts in the early 20’s, anytime between the ages of 15 and 45.

The common cause is genetic in origin. Unknown viral infections also may cause it.

Hearing Impairment from Otosclerosis

The amount of hearing loss due to involvement of the stapes bone and of the nerve can be determined by the hearing tests like Audiometry and clinical tests with tuning forks.

Treatment of Otosclerosis

A) Medical

There is no medical treatment for this condition. Medicines won’t work to improve this type of hearing impairment due to Otosclerosis.

The supplements containing fluoride may be useful in these patients to stabilise the amount of hearing loss. This may help by stabilising the disease process.

B) Hearing Aids

For those patients who are not interested in surgery or not able to take surgery due to other medical conditions like uncontrolled hypertension, diabetes or old age, hearing aids are alternative. The main disadvantage is that you have to wear hearing aids lifelong along with it; you need to bear maintenance of hearing aids when the option of surgical treatment gives you near normal hearing.

C) Surgical

The stapes operation (Stapedectomy or a modified Stapedectomy called Stapedotomy) is recommended for these patients with otosclerosis who are candidates for surgery.

The Stapes operation is usually performed under local anaesthesia. You may require few days of hospital admission and few days of bed rest at home.

A small opening is made in the footplate of the stapes and a stapes prosthesis like a Teflon, stainless steel, titanium, or platinum piston is then placed into this opening and connected to the Incus, second hearing bone.

The stapes prosthesis allows sound vibrations to pass from the eardrum to the inner ear fluids and thus restoring the sound transmission chain and improves hearing. Most patients can return to their work in seven days depending on their occupation.

What are the risks of Stapedectomy operation?

The occurrence of potential complications of Stapedectomy operation is very rare with our microsurgeons who are well trained in Micro Ear Surgery as we are having experience in performing these surgeries on a regular basis with latest micro surgical techniques

However, any surgical procedure carries potential risks which are all discussed with the patient and/or family prior to surgery. Common complications are:

Hearing loss: There is 1 percent risk of hearing loss in the inner ear.

Dizziness: Sometime you may experience dizziness immediately after the surgery, usually it resolves itself within a day or in few days.

Facial paralysis: The course of the facial nerve that innervates the muscles of the face passes through the ear. It may get injured during the operation and lead to facial paralysis. This affects the movement of the facial muscles for rising of the forehead, for making a smile and for closing of the eye. It may occur immediately after surgery or delayed. Recovery of the nerve can be complete or partial.

Tinnitus (noise in the ear): This can occur with surgery.

Taste abnormalities: Some patients may experience an abnormal taste in the mouth or some dryness of the mouth. This problem may improve over time.

Stapedectomy success rate

These operations are successful in restoring the hearing impairment permanently over 97 percent of cases. We at MicroCare ENT Hospital and Research institute achieved world class success rate with our micro surgical techniques.

Precautions after Stapedectomy Operation:

One should not go for air travel for 6 weeks after the surgery. And also should not enter deep mines. The air pressure changes during these activities may impact middle ear where your surgery has been done.

One should not plan to drive a car from the hospital to the home, but you can travel in a car.

Hearing Improvement following Stapes Surgery

Hearing improvement may be noticed during the surgery itself and it can be demonstrated on the operating table. It may not be noticeable immediately after operation as swelling in the ear develops or due to packing the ear. Later on hearing improvement may be apparent within three weeks of surgery depending upon on how the ear heals

In some patients, hearing improvement may not be there or is partial or temporary or it may decrease. But this is very rare due to causes like facial nerve bundling around stapes or inner ear fluid abnormalities where surgery itself becomes difficult.

Can Stapedectomy operation be performed in both ears at the same time?

No. This operation is performed in one ear at a time. If the surgery is needed in the second ear, it can be performed 6 weeks after the other ear surgery.

Grommets

What is Glue Ear?

The normal secretions of the lining of the middle ear which keeps it moist sometimes become thick because of poor ventilation. This condition with thick glue in the middle ear is called Glue Ear.

How did the ‘glue’ get there?

Middle ears on either side are connected to the back of the nose by the Eustachian tube. This Eustachian tube is a potential space, normally closed but opens for a moment with each swallow or yawn that we do. A bubble of air enters the middle ear and excess normal fluids empties out at that moment.

The normal fluid accumulates and in time thickens into glue when cannot empty out in conditions like adenoid, sinus problems, or when muscles of Eustachian tube don’t work or when lining of the Eustachian tube is congested.

What are grommets?

Grommets are ventilation tubes inserted into your ear drum in a minor procedure. These ventilation tubes allow air enter into the middle ear space behind the ear drum. The free ventilation reduces the risk of fluid building up there and if an infection occurs, the pus flows out through the grommet.

Grommets are recommended if you have glue ear that is persistent for more than one or two weeks.

How do grommets work?

Grommets maintain normal middle ear pressure by allowing air into the middle ear space. This reduces the risk of fluid getting accumulated in that space and allows the normal fluids in the middle ear drains into the throat through a connecting tube called Eustachian tube. This reduces the pain you suffer. If an ear infection does occur, the resultant pus flows out through the grommet, limiting the pain you suffer. Even when infection is there, it helps your topical medicines reach middle ear better than oral tablets and are more effective.

When the ear drum retraced back sometimes due to causes of nose like recurrent cold, sinus problem, grommet insertion byes you time till your root cause of it get corrected and helps your ear drum getting back to normal position.Most grommets usually stay in place over the ear drum for about 2 to 6 months and come out by themselves through a natural skin cleaning process.

What are indications of Grommets?

Grommets are recommended for hearing loss due to glue ear that is not cleared with medicines or in case of frequent episodes of middle ear infections or retracted ear drum due to causes like sinus problem or adenoid which sit at the end of the Eustachian tubes at the back of the nose or tonsils.

How successful is the operation?

Usually, grommets help you to restore your middle ventilation till the primary cause is cured. The surgery usually takes about 10 to 15 minutes. It can be done as an OPD procedure and you can go home immediately after the procedure. You will have immediate improvement in hearing. Ear discharge after grommets have been inserted is usually treated with ear drops.

Are there any complications with Grommets operation?

There are no complications usually but sometimes an ear discharge may develop which can be treated with topical drops or antibiotic medicine. Sometimes minor damage and scarring to the eardrum may occur but this is unlikely to cause any problems. A small hole persists in the eardrum rarely after the grommet has come out, this can be fixed a small procedure.

What are precautions with grommets in place?

It is recommended that water should not enter into your ear after this procedure especially when swimming, showering and bathing. Use cotton applied with Vaseline or plugs to put in the ear before use of water.

Laser Ear Surgeries:

Advantage of Lasers in micro ear surgery

Latest laser technology provides a precise and bloodless operating method on the delicate structures of the ear. Lasers used in micro ear surgery are CO2 (carbon dioxide), Argon and KTP lasers. CO2 laser energy due to its unique physical characteristics is being used by ENT surgeons as it provides high precision and control during micro ear surgery. It also provides no-touch dissection tool ideal to use around the delicate structures of the middle ear, performed without vibrational trauma to the hearing bones within the inner ear, making this a safer procedure.

The chief advantage of Lasers is that it can stop bleeding (microvascular coagulation) while cutting the tissue because of their selective absorption in the red spectrum. Lasers can also vaporize target tissue by evaporating the water inside its cells. It helps in removing layer-by-layer removal of diseased tissue.

Lasers are especially useful in micro ear surgeries like Stapedectomy and in removing inflamed tissue in surgery of cholesteatoma, enhancing hearing results and surgical outcomes.

Co2 – Laser Assisted Stapes Surgery

In Stapedectomy operation for otosclerosis, the laser is used to remove the calcified and fixed stapes bone with minimal trauma to surrounding structures. In addition, it helps to make an opening into the inner ear with precision to the desired diameter that only the laser can afford. As it is no-touch tool, outcomes after surgery are improved by decreasing manipulation of the hearing bones. The superficial absorption of CO2 laser energy in the perilymph may help to minimize the risk of damage to underlying inner ear structures.

Co2 – Laser Assisted Tympanoplasty Surgery

CO2 laser technology can be utilized in patients with chronic ear disease, allows removal of diseased tissue with no-touch dissection and decreases the potential for recurrence of disease.

The laser technique is used for removal of diseased tissue during the following micro ear surgical procedures:

Revision procedures (e.g. Tympanoplasty, Mastoidectomy)

Tympanoplasty & Mastoidectomy

Tumor Removal (Glomus Tympanicum, Acoustic Neuroma)

Ossicular Chain Reconstruction

Adhesion ablation

Scar tissue dissection

Cholesteatoma removal

Debulking and coagulation of vascular tumors

Meniere’s Surgeries

A) Minimally Invasive Meniere’s Surgery

Dexamethasone & Gentamycin Perfusion of the Inner Ear

Meniere’s disease which is not responding to medical treatment can now be treated with minimally invasive office surgical treatments. Surgical options for the treatment of Meniere’s disease were all causing complications which were not well tolerated by patients. However, over the last 10 years, minimally invasive surgical treatments have become common procedures performed to control Meniere’s disease, if medical therapy is unsuccessful.

When is inner ear perfusion of chemicals done?

Inner ear perfusion is performed in patients in whom vertigo from Meniere’s disease is uncontrolled with standard medical treatment and behavioural lifestyle changes over a period of several months. When the severity of the vertigo is more and frequent attacks of the vertigo, this procedure is performed.

How is the procedure performed?

These techniques are generally called INNER EAR CHEMICAL PERFUSIONS. The Minimally Invasive treatment involves the injection of a medication through an anesthetized ear drum. The medication then through a membrane, called the round window membrane passes into the inner ear. It results in control of the vertigo attacks in most patients and it may also improve hearing in some patients. The exact mechanism and reason why this chemical perfusion treatment works is not totally understood. It may be with anti-inflammatory effect or some other unknown effect. This is usually performed in a series of three treatments separated a week apart.

What chemicals are used?

The two medications which are frequently used in inner ear perfusions are Dexamethasone and Gentamycin. Of the two, the Dexamethasone Inner Ear Perfusion has become the front line treatment for uncontrolled Meniere’s disease.

How successful is the procedure of Dexamethasone inner ear perfusion?

Dexamethasone Perfusion of the Inner Ear has certainly become the preferred surgical treatment for the uncontrolled vertigo of Meniere’s disease as the concentration of Dexamethasone that can be achieved in the inner ear is higher than what can be obtained by taking Dexamethasone orally.

Studies have demonstrated, there is up to an 80-90% successful rate to Dexamethasone perfusions.

If this treatment of Dexamethasone perfusions fails to control the Meniere’s disease, then other options may include Gentamycin perfusion or other more radical surgical techniques are done.

Gentamycin Perfusion of the Inner Ear

Gentamycin perfusion of the inner ear is done when Dexamethasone perfusion of the inner ear is unsuccessful in controlling vertigo. This is done in those patients where some impairment of hearing present.. Gentamycin works by reducing the function of the receptors of the balance nerve.

What are complications?

Gentamycin perfusion of the inner ear is very effective technique but there is a higher risk of further hearing loss with this technique. But with Dexamethasone, chance of hearing loss is very less.

B) Endolymphatic Sac Decompression (ELS)

It is the most frequently recommended surgical procedure after inner ear chemical perfusion.

What is done in ELS

Endolymphatic sac is present in the inner ear and it drains fluid from the inner ear. When the sac is opened and shunt is placed to allow the future drainage in this surgical procedure, it reduces the fluid pressure in the inner ear which would then subsequently reduce the frequency of vertigo attacks and improves the hearing. The risk of the hearing loss is less from this procedure.

Success Rate

The operation is only successful in approximately 2/3 of patients who underwent this procedure. ESD does NOT cure Meniere’s disease. Vertigo subsides in about 70 percent of Meniere’s cases. But vertigo may recur again with the same severity as before in a significant number of individuals within three years of surgery.

Other Procedures

C) Labyrinthectomy: This procedure is offered if the patient has near profound hearing loss. This procedure destroys the remaining nerve of the hearing, but gets the good control of balance. This is usually curative as the nerve of balance is completely removed.

With the development of cochlear implants, this procedure is offered less nowadays.

After the surgery, the opposite ear takes over the command of the entire balance function and assumes full control in a week. The brain will adapt to this new situation where it is now receives only correct signals from the one remaining inner ear which will control the entire balance function. This is the reason why Labyrinthectomy is successful. The patient experiences a period of mild to moderate dizziness that may last six to eight weeks.

D) Vestibular Neurectomy: An intracranial procedure is generally a team effort performed by an ENT surgeon and a neurosurgeon. If there is substantial hearing present, this procedure may be a preferred surgical option. It offers excellent control of vertigo, generally with preservation of hearing.

Vestibular Neurectomy involves the discrete section of the balance nerve thus preserving the hearing portion of the nerve. 90 to 95 percent of patients with vertigo, vestibular neurectomy will result in cure of vertigo. Recovery from this procedure is similar to that of Labyrinthectomy procedure.

Glomus Tympanicum surgery

The size and the extent of the glomus tumour determine the surgical procedure needed. Glomus tumours can be as small as 2 to 3 mm and expand to fill the middle ear.

Many glomus tumours can now be approached through the ear canal, if large form behind the ear and then destroying the tumour completely with CO2 laser or removed with more radical surgeries.

Larger tumours may surround the hearing bones. In this situation, tumour can be vaporized away from the bones of hearing without separating them.

When the tumour is attached to the jugular vein or sometimes invades the jugular vein as it enters the mastoid bone. In these cases, the tumor must be completely removed from the jugular vein.

If the tumour has invaded and entered the brain, intracranial surgical excision of the tumour may be necessary.

Results of surgery of glomus tumours of the middle ear and mastoid are extremely good in most cases. But when the tumour has invaded the inner ear, facial nerve or brain, more complications arise.

Advances in the imaging like CT scan MRI and refinements of traditional surgery have made the correct diagnosis and complete excision of these tumours possible in most of cases.

Intratympanic Gentamicin

See Dexamethasone & Gentamycin Perfusion of the Inner Ear.

Cochlear Implant Surgery

See Cochlear Implant Surgery

Facial Nerve Surgeries

Paralysis of the facial nerve is the paralysis of muscles of face. It causes significant functional and aesthetic compromise like inadequate protection of the eye with a real risk of exposure keratitis, swallowing, drooling and speech difficulties.

The degree of suffering often varies from patient to patient especially younger people who may experience tremendous psychosocial distress about their condition. Poor self-image and difficulty interacting with peers and family members can be devastating in the social life.

Causes of Facial Nerve Paralysis

Congenital facial paralysis is very rare.

Idiopathic facial paralysis also known as “Bell palsy” is the most common type. It is often due to virus induced inflammation of the facial nerve that results in swelling and functional compromise of the nerve. Facial nerve repair surgery is not required frequently in these cases because most of these patients regain the function of the facial nerve spontaneously. Facial nerve decompression can be done in selected cases when paralysis is permanent.

Traumatic facial nerve paralysis from intraoperative injury, penetrating trauma is also common type. Operations like acoustic neuroma surgery put the facial nerve at risk. Sometimes, it may occur in mastoidectomy operation at the hands of unskilled surgeons. Any facial nerve injury sites can be repaired, except when injury occurs near the nerve root, where the available stump of the facial nerve may not be long enough to allow repair.

Tumours like that of parotid gland, facial nerve schwannomas, acoustic neuromas and neoplasms of the brain are some of the less common causes.

Viral infections like herpes zoster (eg, Ramsey Hunt syndrome), mumps, Coxsackie virus and mononucleosis. Bacterial infections like sequelae of otitis media and Lyme disease.

Methods of Facial Nerve Repair Surgery

The cause of the facial nerve paralysis determines the likelihood of spontaneous return of function of the facial nerve. Most cases of idiopathic facial nerve paralysis (Bell palsy) spontaneous return occur. The transacted facial neve must be repaired if satisfactory return of function is to be achieved.

Now with the modern techniques of facial nerve repair, most patients benefit greatly. Several different procedures of facial nerve repair are available today like direct repair, cable nerve grafting, nerve crossover techniques and Facial nerve decompression and dynamic reconstruction for facial nerve paralysis. Newer techniques as possible alternatives to suture repair include laser neurorrhaphy and tissue adhesive repair.

Retro Sigmoid Skull Base Surgeries

The Fully Endoscopic Retro Sigmoid Approach for skull base surgeries is the latest development in the field of ENT.

Significance and Advantages of Fully Endoscopic Retro Sigmoid Approach for skull base surgeries

The Main limitation operating microscope is in viewing angles of skull base in micro surgeries, makes it difficult for the surgeon to view and remove peripheral margins of tumours. These are not always completely exposed microscopically. By contrast, the endoscope gives the surgeon broad panoramic view and different angles of view.

Endoscopic approach to the brainstem region with angled endoscopes allows the surgeon to visualize areas that were often hidden from the direct of view of the operating microscope.

The improved exposure of the entire tumour with virtually no brain retraction has reduced the risk of injury to the brain and the surrounding cranial nerves results in a more complete tumour removal decreased the time required to access skull base angles. This allowed rapid recovery and minimal postoperative discomfort to patients.

Endoscopic procedures pose no additional risk to the patient and add no additional time to the total duration of surgery.

What conditions this technology is applicable

This fully endoscopic retrosigmoid approach is useful to access schwannoma or meningioma or vascular loops involving cranial nerves V through XII in the skull base regions of the cerebellopontine angle (CPA), petroclival and foramen magnum.

Conditions like Trigeminal Neuralgia, Hemifacial Spasm and Glossopharyngeal Neuralgia are well treated with technique.