DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Meniere’s disease.
POSTOPERATIVE DIAGNOSIS: Meniere’s disease.
PROCEDURES PERFORMED:
1. Right endolymphatic mastoid shunt.
2. Inner ear perfusion.
SURGEON: John Doe, MD
ANESTHESIA: General.
INDICATION FOR PROCEDURE: The patient is a (XX)-year-old with medically-refractory Meniere’s disease. Following lengthy discussion regarding management strategies, the patient has opted for operative intervention with endolymphatic mastoid shunting.
DESCRIPTION OF OPERATION: Following the satisfactory instillation of oral endotracheal anesthesia, the right ear was prepped and draped in the usual fashion. Xylocaine 1:100,000 epinephrine was instilled in the postaural area. The ear was debrided of ceruminous material and squamous debris and copiously irrigated with sterile saline. The Xomed facial nerve monitor NIM-2 unit was set with active electrodes to the orbicularis oculi and marginal mandibular with ground electrode to the dependent shoulder. The monitor was left in the ON position during the course of surgery.
A postaural incision was made and carried down through the skin and subcutaneous tissue. Areolar tissue was harvested and set aside on the back table. With the T-shaped incision now made through the pericranium, the mastoid cortex was exposed. Using continuous otomicroscopic visualization, suction irrigation and a cutting bur, cortical mastoidectomy was done. Tegmen was identified superiorly, the sigmoid sinus posteriorly, the sinodural angle was saucerized to the aditus ad antrum where the horizontal canal and lateral process of the incus were identified. The vertical segment of the facial nerve was outlined and perilabyrinthine cells were identified. The posterior semicircular canal was identified and the retrolabyrinthine, presigmoid space was decorticated down to the posterior fossa dura.
Using a diamond polishing bur, the bone over the dura was now eggshelled. The vertical segment of the facial nerve, outlined retrofacial cells, and infralabyrinthine cells were opened as an Arenberg type II sac was identified. With hemostasis achieved, the outer wall of the sac was incised. The lumen was identified and a reinforced piece of Silastic sheeting was placed in as a drain. The patient was valsalva’d. There was no evidence of CSF leakage, and an areolar graft was placed lateral to this. Now, the middle ear space was evacuated of bone dust and blood. Through a posterior tympanotomy, 0.6 mL of Solu-Medrol was perfused through the round window niche.
The patient tolerated this procedure well. The pericranial flap was closed in layers. Subcutaneous and skin closure was now accomplished. A dry sterile compression dressing was applied. The Xomed monitor was removed. The patient was awakened from anesthesia and delivered to the recovery room in satisfactory condition.
