January 17, 2015
Let's review another video to discuss intraoperative findings during a selective vestibular neurotomy for Meniere's disease. This is a 61-year-old female who presented with a disabling intractable vertigo tinnitus and fullness in her right ear. She underwent a number of previous procedures as it is typical for these patients and subsequently was referred for a vestibular neurotomy. You can see the previous incisions in the back of her ear for a mastoid shunt, most likely. We have to tailor our incision, usually, in these patients to assure that there is adequate vascular pedicle for the incision to heal. You can see the typical location of the dural sinuses in the mastoid groove. A right-sided retro mastoid craniotomy was subsequently completed. You can see the junction of the transfers and sigmoid sinuses. The dural is open along these dural sinuses and a small meningeal artery is coagulate and cut. You can see the, under high magnification, the nerve. The vestibular portion is often more grayish than the cochlear portion. There is often an arterial between the two components. The sector can be used to exaggerate this plane between this component. A scissor and a sickle knife may be used to cut the superior component in layers while they labyrinthine artery and the facial nerve anteriorly are carefully protected. You can see the labyrinthine artery in this case, and further anteriorly the facial nerve will be in view. Thank you.
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