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Endolymphatic Sac Decompression

Menieres syndrome

1. Planning of the incision. 2. Elevation of the skin flap anteriorly.
3. Elevation of the periosteal flap posteriorly. 4. Starting mastoidectomy.
5. Antrotomy. The short process of the incus and the lateral semicircular canal are seen. 6. Drilling in the region of the mastoid tip searching for the digastric ridge.
7. Digastric ridge. The change in the colour of the muscle is seen. Medially, the area of the sigmoid sinus. 8. Drilling for the skeletonization of the sigmoid sinus.
9. The sigmoid sinus is seen. 10. Drilling anteriorly the sigmoid to uncover the dura of the posterior cranial fossa and the endolymphatic sac.
11. Removing the mastoid air cells behind the facial nerve and below the labyrinth. 12. A rough image of the lower limit of the posterior semicircular canal.
13. Drilling to uncover the dura of the posterior cranial fossa and the endolymphatic sac. 14. Removing the bone above the jugular bulb and medially to the facial nerve.
15. Detachment of the dura from the medial surface of the temporal bone. The formation of the Bills island on the sigmoid is seen. 16. The endolymphatic sac is seen almost fully uncovered (beneath the round knife).
17. Trying to remove the bone medially the sac. We do not recommend opening the sac. 18. Completion of the operation, suturing the wound, and insertion of a ventilation tube.