左侧乳突表皮样囊肿-曹春秀.ppt

Case preoperative reportDiagnose: Left mastoid process epidermoid cyst Surgeon: Zhang Qiuhang Date: Feb 11th 2009 Case character• Cao Chunxiu, female, 40 y/o; • HPI: the patient suffered from tinnitus on left ear 2 months ago and tinnitus aggravated 2 weeks ago following with headache, dizziness, several vomiting, hypodynamia on right limbs; • PE: left auditory acuity decreased; – right limbs muscle force is 4 grade.BERA and CTLeft auditory acuity Left mastoid processMRI: 1/28/2009Distance to ICA Left sigmoid sinus MRI: 1/28/2009No enhancement Totally outside duraMRI: 1/28/2009MRI: 1/28/2009Diagnose, approach and steps• Punctured and sucking fluid, open capsule wall to resect soft content; • Removal capsule wall and grind mastoid process until air cells disappeared if necessary; • Pedicle muscle packing tumor bed and iodoform gauze through external auditory canal packing mastoid process defect.Left mastoid process epidermoid cyst Left mastoid process approachKey points• Mastoidotympanectomy (乳突根治术) – Air cells must be totally ground open; – As grinding mastoid process, facial canal beneath horizontal semicircular canal must not be grinded open to evade facial paralysis; • Left sigmoid sinus – Disappearance or unblocking approach; – Blocking approach, give deligation at sigmoid sinus and internal jugular vein (must be higher than facial vein to avoid back flow of blood). Postoperative treatment• Exchange iodoform gauze through external auditory canal until mastoid process epithelization.。