Precise access to key structures of the inner ear and skull base
In this video, uploaded to the online surgery app SurgSchool, the Dr. Luis García Ibáñez, a renowned specialist in otology and temporal bone surgery, performs a labyrinthectomy complete with approach to the endolymphatic sac, jugular vein y semicircular channels, in his annual temporal bone dissection course. This procedure, recorded step by step with magnified, high-quality images, is a masterful example of advanced anatomical dissection of the inner ear.
Location and opening of the endolymphatic sac
The intervention begins with the reaming anterior to the sigmoid sinus, accessing the presigmoid area where the splitting of the dura mater that covers the endolymphatic sacThis whitish structure, with superficial vascularization, is opened without invading the endocranial space, exposing the sac in its entirety.
Identification of the jugular vein
Following the lateral sinus, the jugular gulf carefully retracting the lateral sinus, which is particularly prominent in this case. Identification of this structure is achieved by progressive milling of the peribulbar cells, located by their reddish or bluish color and changes in bone density. This stage is critical for skull base surgeries that require exposure of the deep venous tract.
Complete labyrinthectomy and exposure of semicircular canals
After accessing the middle ear through posterior tympanotomy, the Dr. García Ibáñez performs the controlled opening of the three semicircular canals (superior, lateral, and posterior). The following are displayed: ampullary and non-ampullary portions, exposing their convergence in the utricle or vestibuleThis anatomical dissection is performed respecting the facial nerve and other neurovascular structures.
The following are also identified:
- La supercuate artery in the dome of the upper channel.
- La penetration of the endolymphatic duct from the sac to the utricular area.
- La anatomical union of the canals at the common cross.
