Abushara Temporal Bone Dissection Manual

Khairy Alhag Abu Shara, M.D. Senior consultant ENT, Head and Neck Surgeon, Sabah and MTC Hospitals, Kuwait

Education: ■ M.D. Ear, Nose and Throat Surgery. May 1992, Faculty of medicine, Cairo University Kasr Al-Ainy Medical School ■ M.S. Ear, Nose and Throat Surgery. May 1985 (very good degree), faculty of medicine, Cairo University Kasr Al-Ainy Medical School ■ M B & Bch Nov. 1981 (very good degree), faculty of medicine, Cairo University Kasr Al-Ainy Medical School Posts: ■ Senior Consultant at ENT department, Sabah and MTC hospitals, Ministry of Health (MOH), Kuwait ■ Lecturer of otorhinolaryngology, department of surgery, faculty of medicine, Kuwait university 1996, ongoing. (Mandated from MOH). ■ X-Chairman of ENT medical council in Kuwait. December 1999 – April 2006. ■ X-Chairman of ENT department, Al-Sabah Hospital, Kuwait, July 1999 – April 2006. ■ Resident at Cairo University Medical School, ENT department, Kasr Al-Ainy Hospital, Egypt, from 2nd March 1983 until 28 Feb. 1986. ■ House officer at Cairo university hospitals, Egypt, from 1st march 1982 – 28 Feb. 1983.

Licensures and activities: ■ Licensed as ENT Consultant in Kuwait, Egypt and Sudan. ■ Referee of the Kuwait Medical Journal. ■ Member of the Faculty of Surgery, Kuwait Institute for Medical Specialization (KIMS) since October 1998, ongoing. ■ X-chairman of the inspection board for private hospitals, MOH, Kuwait. ■ X-Member of the operational policy follow-up team MOH, Kuwait. ■ X-Member of the accreditation standards setup committee for hospitals and primary health care centers, MOH, Kuwait. ■ Visiting professor, Khartoum university, faculty of medicine. ■ Director of the first temporal bone course, Kuwait, November 2005. Publications: 19 publications in national, regional and international journals, 12 presentations, 8 posters and booklets. Awards and certificates of honor: 1. From KMA on the occasion of obtaining the M.D. degree. 2. From the Egyptian medical syndicate on the occasion of obtaining the M.D. degree. 3. The first prize of the 11th course in otology and otoneurosurgery, 5–7 Dec. 2000, hôpital Purpan, Toulouse, France. 4. From the 3rd International Conference of the Gulf Cooperation Council (GCC) Otorhinological, Head & Neck Societies & Associations. March 98. 5. From the Sudanese ENT association. 6. From the minister of health of Kuwait for editing the operational policy of the ENT departments in Kuwait, May 2000. 7. From the minister of health, Kuwait, for the 3rd edition of the operational policy of the ENT departments in Kuwait, Febr. 2002. 8. Support for research from the “Kuwait Foundation for Advancement of Science” (KFAS). 9. From the faculty of surgery, Kuwait Institute for Medical Specialization (KIMS) 10. From the director of Sabah medical area.

DISSECTION MANUAL FOR THE TEMPORAL BONE LABORATORY KHAIRY ALHAG ABU SHARA, M.D. Senior Consultant ENT, Head and Neck Surgeon Sabah and MTC Hospitals, Kuwait X-Chairman of ENT Medical Council – MOH 99-06

To my mother, from whom I have learned how sincere hard work can be an endless source of enjoyment. To my Family, for their unlimited support and understanding of the medical profession as well as its obligations and commitments.

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Dissection Manual for the Temporal Bone Laboratory

Acknowledgement The growth of medico-legal problems related to surgical practices necessitates greater emphasis on clinical training. Lab practice on cadavers and various models is becoming increasingly popular for both research and training. The challenges of ear surgery are unique because the density of anatomical structures in a relatively small space is unlike any other organ in the human body. This consequently calls for extensive lab training before starting to operate in the theater—a step that should only be taken once both the trainer and trainee are satisfied with the level of skills achieved. For those reasons, the establishment of a temporal bone lab within the otology center is an inevitable option. Considering the short time frame given during a temporal bone dissection course – in which the participants are concerned mainly with handson training rather than going into further theoretical details – this manual nevertheless provides practical and concise orientation to the topic. The author’s aim was not to write a textbook, but to address the actual needs in a temporal bone lab, which is why this manual should be supported by more detailed training instructions and further readings. I hope, this booklet will be of great help to our junior candidates and to the seniors who are planning to establish a temporal bone lab. A special word of gratitude goes to KARL STORZ company for their kind support and valuable assistance in the preparation of this booklet. Khairy Alhag Abu Shara, M.D. Senior Consultant ENT, Head and Neck Surgeon Sabah and MTC Hospitals, Kuwait Email: [email protected] Phone: 00965 9784104


Foreword Middle ear surgery involves procedures that are among the most challenging in the field of ORL, demanding a high degree of technical skill, expertise and precision. To become a proficient otologist requires good orientation skills and thorough knowledge of numerous anatomical structures confined to a space amounting to less than one cubic inch. Furthermore, the introduction of the surgical microscope, dental drill and fine instruments requires the development of precise operative techniques. The introduction of high-resolution CT scanners, 1 mm cuts and MRI enables surgeons to gain a more detailed knowledge of fine anatomical structures, e.g., the thickness of the stapes foot plate in stapes surgery, the facial nerve anatomy, and the possibility of any associated congenital anomalies in cochlear implantation. Full anatomical orientation regarding both normal and abnormal variants is the first step to be taught in temporal bone labs. Otherwise avoidable complications could occur. It has been suggested by many authors that prior to performing in-vivo surgery in an operating theater, a trainee surgeon should acquire good knowledge of temporal bone anatomy and develop proper navigational skills to such a degree comparable to the uncanny sense of direction that allows us to find our way through our own bedroom in complete darkness. It takes a long time to become an ear surgeon and even more time to gain the required level of proficiency to successfully manage difficult and complicated cases. The temporal bone dissection lab provides an entry point, where candidates can devote their efforts to working toward this goal. In this manual, information is given about the anatomy of the temporal bone, the various surgical procedures, that can be practiced on cadaver specimen in the lab (including photos, adressing procedures, and concepts), imaging procedures, and a suggested temporal bone laboratory setup.

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Anatomical schematic drawings: Mr. Andreas Mücke Karl-Frank-Str. 32 12587 Berlin, Germany

Dissection Manual for the Temporal Bone Laboratory Khairy Alhag Abu Shara, M.D.

Most of the photographs shown in this manual were taken by the author during dissection sessions in the temporal bone laboratory.

Address for correspondence: Khairy Alhag Abu Shara, M.D. Senior Consultant ENT, Head and Neck Surgeon Sabah and MTC Hospitals, Kuwait Email: [email protected] Phone: 00965 9784104

Please note: Medical knowledge is constantly changing. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy may be required. The authors and editors of the material herein have consulted sources believed to be reliable in their efforts to provide information that is complete and in accordance with the standards accepted at the time of publication. However, in view of the possibility of human error by the authors, editors, or publisher of the work herein, or changes in medical knowledge, neither the authors, editors, publisher, nor any other party who has been involved in the preparation of this work, can guarantee that the information contained herein is in every respect accurate or complete, and they cannot be held responsible for any errors or omissions or for the results obtained from use of such information. The information contained within this brochure is intended for use by doctors and other health care professionals. This material is not intended for use as a basis for treatment decisions, and is not a substitute for professional consultation and/or peerreviewed medical literature. Some of the product names, patents, and registered designs referred to in this booklet are in fact registered trademarks or proprietary names even though specific reference to this fact is not always made in the text. Therefore, the appearance of a name without designation as proprietary is not to be construed as a representation by the publisher that it is in the public domain. All rights reserved. No part of this publication may be translated, reprinted or reproduced, transmitted in any form or by any means, electronic or mechanical, now known or hereafter invented, including photocopying and recording, or utilized in any information storage or retrieval system without the prior written permission of the copyright holder.

Senior Consultant ENT, Head and Neck Surgeon Sabah and MTC Hospitals, Kuwait X-Chairman of ENT Medical Council – MOH 99-06

© 2007 Endo-PressTM, Tuttlingen, Germany ISBN 978-3-89756-151-9, Printed in Germany Postfach, D-78503 Tuttlingen Phone: +49 74 61 145 90 Fax: +49 74 61 708 529 E-mail: [email protected] Editions in languages other than English and German are in preparation. For up-to-date information, please contact Endo-PressTM Tuttlingen, Germany, at the address mentioned above. Printed by: Endo-PressTM Tuttlingen, Germany Braun Druck+Medien, D-78532 Tuttlingenj, Germany

11.07-2

All rights reserved. No part of this publication may be translated, reprinted or reproduced, transmitted in any form or by any means, electronic or mechanical, now known or hereafter invented, including photocopying and recording, or utilized in any information storage or retrieval system without the prior written permission of the copyright holder.


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Table of Contents

Acknowledgement ...................................................................................................................

4

Forword......................................................................................................................................

5

1.0 Introduction ........................................................................................................................

8

2.0 Training Procedures............................................................................................................

13

3.0 Endoscopic Views of the Temporal Bone .........................................................................

24

4.0 Temporal Bone CT Images 4.1 Axial CT Scans ............................................................................................................. 4.2 Coronal CT Scans .......................................................................................................

28 35

5.0 Exposure of the Temporal Bone: Genuine Dissections...................................................

39

Remember .........................................................................................................................

42

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1.0 Introduction

Squamous portion

Petrous portion

Mandibular fossa Tympanic portion Zygomatic process Mastoid portion Styloid portion

Fig. 1 Left temporal bone, lateral view with the squama sculptured as an auricle. There are two temporal bones. Each is composed of five parts: mastoid, petrous, squamous, tympanic plate and styloid process.

Internal auditory meatus Basisphenoid Nerves of the jugular foramen Basiocciput

Sigmoid sinus

Jugular tubercle Vessels of the jugular foramen

Hypoglossal canal

Occipitomastoid suture

Occipital condyle

Squamous part of the occipital bone Fig. 2 Right temporal bone attached to the occipital bone. View of the posterior cranial fossa. The internal auditory meatus (IAM), jugular foramen and notch, sigmoid sinus, superior and inferior petrosal sinuses, petrous apex, clivus, and hypoglossal canal can be seen.


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Foramen rotundum

Superior orbital fissure

Foramen spinosum

Foramen ovale Anterior clinoid process

Superior petrosal sulcus

Internal carotid artery Foramen lacerum

Occipital condyle Sella turcica

Clivus Fig. 3 Right temporal bone attached to sphenoid and occipital bones. View of the middle cranial fossa. The foramina (rotundum, ovale, spinosum, and lacerum), the superior orbital fissure, internal carotid artery, anterior clinoid process, clivus, petrous apex, cavum trigeminale, greater wing of the sphenoid, petrosphenoid and petro-occipital suture lines are visible.

Mandibular fossa

Zygomatic root

Tympanic plate

Squamo-sphenoid suture

Mastoid tip Stylo-mastoid foramen

Foramen spinosum

Digastric fossa Foramen ovale Styloid process Carotid canal

Jugular tubercle

Occipital condyle

Jugular bulb

Fig. 4 External view of the skull base. The jugular foramen, carotid canal, greater wing of the sphenoid, the foramina (ovale, spinosum, lacerum), zygomatic root, mandibular fossa, styloid process, squamo-sphenoid suture, occipital condyle, digastric fossa, stylo-mastoid foramen, and mastoid tip are visible.

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Superior SCC Cochlea

Common crus Oval window

Posterior SCC

Lateral SCC

Fig. 5 Right inner ear. The three semicircular canals (SCC) are open, the lateral, the posterior and the superior with crus commune are visible. The cochlea and oval window are also exposed.

Superior SCC

Lateral SCC Oval window Facial nerve Modulus

Remnant of promontory

Cochlea: basal turn Round window

Fig. 6 Left inner ear. The superior and lateral SCC, facial nerve, oval and round windows, cochlea, modulus, and promontory.


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Malleus handle and tympanomeatal flap

Long incus process

Lenticular incus process

Stapes head Incudo-stapedial joint

Promontory

Stapedial tendon

Fig. 7 Anatomy of the left middle ear: The incudo-stapedial joint, the stapes head and the crura, facial nerve, stapedial tendon, promontory, and tympanomeatal flap are visible.

2 Incus

1 Malleus Head Neck

Short process Body Lenticular process

2 1

Long process

Lateral process Handle

3 Stapes Posterior crus Head Neck

3 Fig. 8 The auditory ossicles. 1 The malleus, head, neck, lateral process, and handle. 2 The incus: body, short, long, and lenticular processes. 3 The stapes: head, neck, anterior and posterior crura, and footplate.

Anterior crus Footplate

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Cochleariform process Semi-canal of the tensor tympani muscle

Facial nerve (transverse segment) Middle ear

Transverse part of the carotid canal Vertical part of the carotid canal

Jugular bulb Carotico-jugular foramen

Fig. 9 Right side dissection. Notice the jugular bulb, carotid canal, both vertical and horizontal parts, carotico-jugular septum, and foramen for the IX cranial nerve, cochlea, oval window, facial nerve, cochleariform process, semi-canal of the tensor tympani muscle, and lateral SCC.


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2.0 Training Procedures General rules • Specimen should be taken out of the refridgerator one hour before dissection. • All needed instruments should be available. • Temporal bone should be in surgical position. • Rapid review of the gross anatomy. • Verify operational integrity of the drill and perform an initial function test . • Leave your bones in a labeled plastic bag.

Sanitary rules • Anti-hepatitis vaccination. • Wear gowns, gloves, overshoes, safety glasses and face mask to prevent bone dust inhalation and entry of a bone splinter into the eye. • Avoid injuries by using proper instruments. • Remaining bones and dust should be handled as medical wastes. • Leave the working area clean and tidy for the next group.

The bones should be removed from the refridgerator at least one hour before dissection. First, determine whether the bone is right or left, and secure it with a temporal bone holder in a

surgical position, as if in the operating theater. The zygomatic root is anterior, and the mastoid tip is inferior (Fig. 10a)

Zygomatic root

External auditory meatus Mastoid tip

Squama

Digastric notch

Fig. 10a Left temporal bone with soft tissues.

Identify important landmarks related to different anatomic views of the temporal bone, for example: • Zygomatic root • Mastoid tip • Digastric notch • External auditory meatus • Squamous part of temporal bone

• Petrous part of temporal bone and its apex • Cavum trigeminale • Arcuate eminence • Internal auditory meatus • Cranial nerves VII, VIII, IX and X (spaghetti-like structure)

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1. Attempt soft tissue procedures, such as: • Periosteal incision and dissection • Dissection of the posterior meatal skin down to the annulus. Sometimes the candidate cannot practice the soft tissue work properly if formalinized specimens or macerated bones are used. The candidate should be familiar with the anatomy of macerated bones (Figs. 10d and 10e).

Vertical and transverse incisions Transmeatal transverse and vertical skin incisions

T- shaped incision

Craniotomy flap

U- shaped incision

Obliteration flap

Fig. 10b Different periosteal incisions and flaps.

The Golden Rules of Drilling: • Hold the drill securely with a steady hand • Never perform blind drilling! • Proper burr type, size and shape. • Parallel direction • Excavate, but never penetrate. • Use suction-irrigation and prevent overheating.

2. Drill a code number on the squama to practice control of the drill handpiece, which should be held and used like a pencil. Never apply undue force to avoid losing control and causing subsequent, potentially catastrophic injury.


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Posterior meatal wall External auditory meatus

Antrum Dural plate

Cells of the mastoid tip

Lateral SCC

Digastric ridge

Posterior tympanotomy

Drill

Sinus plate

Fig. 10c The art of drilling.

Squama

Zygomatic root Mastoid

External auditory meatus

Tympanic plate Carotid canal Digastric notch Petrous bone

Fig. 10d Anatomy of macerated bones. Lateral surface.

Squama

Mastoid Arcuate eminence Petrous bone Internal auditory meatus

Fig. 10e Anatomy of macerated bones: Medial surface.

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Fig. 10f Left myringotomy and grommet insertion.

Malleus handle and tympanomeatal flap

Long incus process

Lenticular incus process

Stapes head Incudo-stapedial joint

Promontory

Stapedial tendon

Fig. 11 Left anterior tympanotomy.


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Tympanomeatal flap Malleus handle

Annulus fibrosus

Chorda tympani Long process of incus

Promontory Incudostapedial joint

Posterior meatal wall

Posterior crus of stapes

Fig. 12a Left anterior tympanotomy (schematic drawing).

Teflon piston

Long process of incus Lenticular process of incus

Pyramidal process

Promontory Shaft

Fig. 12b Left stapedectomy and teflon piston insertion.

3. Practice myringotomy and grommet insertion (Fig. 10f). 4. Practice anterior tympanotomy: a tympanomeatal flap is created by removal of the posterior meatal wall and exploration of the middle ear (Figs. 11, 12a). Practice stapedectomy and teflon piston insertion (Fig.12b) In-vitro fixation can be achieved by injecting adhesive glue around the footplate or into the labyrinth through a “decapitated” superior SCC at the arcuate eminence.

Check the annulus, incudo-stapedial joint, stapes suprastructures, stapedial tendon, pyramidal process, facial nerve, chorda tympani, malleus handle, tympanic membrane, promontory, and round window.

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Zygomatic root Antrum External auditory meatus Squama


Lateral SCC

Tip cells Sinus plate

Dural plate Sinodural angle

Fig. 13 Right cortical mastoidectomy.


Lateral semicircular canal

Posterior meatal wall Facial nerve

Dural plate Digastric ridge Antrum

Sinus plate Sinodural angle

Fig. 14 Right cortical mastoidectomy (schematic drawing).

5. Perform myringoplasty, in which a piece of periosteum is harvested and used as a graft which is positioned with the underlay technique to repair a previously created tympanic membrane perforation. 6. Practice a cortical mastoidectomy (Figs. 13, 14). Identify the spine of Henle, then start with the largest cutting burr in the MacEwen’s triangle between the inferior temporal line, tangent to the posterior meatal wall and the spine of Henle. This triangle

serves as a landmark for localizing the mastoid antrum. Drilling should be accompanied by continuous irrigation and performed parallel to the anticipated border without leaving behind any overhangs. Never work blindly. The antrum, which is the largest mastoid air cell, has the lateral SCC on its floor. Cells over the dural and sinus plates are drilled, the sinodural angle is identified, and cells behind the sinus are cleared. Identify the digastric ridge and clear the peri-facial and deep mastoid air cells. Keep the posterior bony meatal wall intact.


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Incus body Posterior meatal wal

Antrum

Incudo-stapedial joint Short process of incus Window of the posterior tympanotomy

Lateral SCC

Facial nerve

Fig. 15 Left posterior tympanotomy.


Body of incus process Incudo-stapedial joint

Promontory Chorda tympani

Round window Dural plate

Facial nerve


Sinus plate

Fig. 16 Left posterior tympanotomy (schematic drawing).

7. Perform posterior tympanotomy (Figs. 15, 16) by initially gaining access to the middle ear from the mastoid cavity while ensuring that the tympanic membrane and annulus remain intact. A cortical mastoidectomy is performed to deepen the sinodural angle and thin the posterior meatal wall. The incus body and its short process are identified. Drilling begins with the 2 mm-diamond burr between the incus short process, chorda

tympani, and facial nerve down to the middle ear. The incudostapedial joint, promontory and round window niche should be visible. Note: You can fill the external auditory meatus with a colored fluid. This fluid should not leak into the mastoid. If leakage occurs, it is an early alarm that the annulus, tympanic membrane or posterior meatal wall was injured.

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Lateral SCC (de-roofed) Perifacial cells Antrum

Posterior SCC (de-roofed) Endolymphatic sac opened with a sickle knife

Sigmoid sinus

Fig. 17 Right saccus decompression.

External auditory meatus Digastric ridge Posterior meatal wall Axis of lateral semicircular canal Axis of posterior semicircular canal

Dural plate

Endolymphatic sac Sinus plate

Sinodural angle Fig. 18 Right saccus decompression (schematic drawing).

8. Identify the endolymphatic sac (Figs. 17, 18). Both lateral and posterior SCCs are exposed but not opened. The peri-sinus cells are drilled, and an imaginary line is passed along the lateral SCC, perpendicular to the poste-

rior SCC. The bone inferior to this line is then thinned out and removed with a needle. The lateral wall of the sac is identified and incised using a sickle knife.


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Cortical mastoid

Nose of the implant dummy in the recess created for electrodes Dummy inserted into the implant site

Fig. 19 Cochlear implant bed.

Posterior meatal wall Second cochleostomy Window of the posterior tympanotomy Cochleostomy

Fig. 20 Right double cochleostomy.

9. A cochleostomy is performed (Fig. 20) after preparation of the cochlear implant bed (Fig. 19) and cortical mastoidectomy with posterior tympanotomy. An attempt can be made under visual control with the cochlea opened from posterior so the electrode is constantly under direct vision during insertion (Fig. 21).

Fig. 21 Electrode hugging the modulus of the right cochlea (counter-clockwise).

Note: This step needs to be performed under supervision of a trainer.

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Zygomatic root Middle ear

Stapes Dural plate

Lateral SCC Tip cells

Sinodural angle

Sinus plate

Fig. 22 Right radical mastoidectomy.

Tendon of the tensor tympani muscle Dural plate Semi-canal of the tensor tympani muscle

Promontory

Cochleariform process

Facial nerve Round window


Stapes Dural plate Sinus plate

Fig. 23 Right radical mastoidectomy (schematic drawing).

10. Perform a radical mastoidectomy (Figs. 22, 23) by drilling through the posterior meatal bony wall down to a level just above a line from the lateral SCC to the digastric ridge, removing the bridge over the attic area, as

well as the anterior and posterior buttresses. The anterior attic is also cleared. Identify the facial nerve, semicanal of the tensor tympani muscle and the cochleariform process tendon. Try to complete an ossiculoplasty procedure.


23

Facial nerve

Superior SCC

Lateral SCC

Posterior SCC

Fig. 24 Left labyrinthectomy.

Stapes Facial nerve Superior semicircular canal Lateral semicircular canal Posterior semicircular canal Dural plate Sinus plate

Fig. 25 Left labyrinthectomy (schematical drawing).

11. Perform a labyrinthectomy (Fig. 24, 25) by first identifying the domes of the three SCC. Open the canals and follow with a small dia-

mond burr to the vestibule. Preserve the anterior part of the lateral SCC to avoid injury to the facial nerve.

24


3.0 Endoscopic Views of the Temporal Bone

Pars flaccida Lateral malleus process

Malleus handle Pars tensa Umbo

Cone of light

Fig. 26 Right tympanic membrane.

Semicanal of the tensor tympani muscle

Tendon of the tensor tympani muscle

Long incus process

Malleus handle Middle ear Tympanic membrane Incudo-stapedial joint Umbo Eustachian tube

Fig. 27 Oto-endoscopic view of the right middle ear through the Eustachian tube.


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Attic Semicanal of the tensor tympani muscle Facial nerve Eustachian tube

Oval window

Mesotympanum

Pyramid Ponticulus promontorii Subiculum promontorii

Promontory

Sinus tympani Round window

Hypotympanic cells

Fig. 28 Left middle ear.

Fallopian canal Bill’s bar Superior vestibular area Transverse crest Inferior vestibular area Cochlear area Singular nerve

Fig. 29 Right internal auditory meatus.

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Fallopian canal Superior vestibular area Bill’s bar Transverse crest Cochlear area Inferior vestibular area

Singular nerve

Fig. 30 Left internal auditory meatus.

Right internal auditory meatus (de-roofed) Spiral lamina Modiolus

Cochlea (opened)

a

b

Fig. 31a, b a Right internal auditory meatus (de-roofed) and cochlea opened with modiolous and spiral lamina visible. b MRI insert image provides orientation about the position of the cochlea in (a).


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Internal auditory meatus Facial nerve

Cochlear nerve

Vestibular nerve

Dural sleeve

Fig. 32 Endoscopic view of the right internal auditory meatus (IAM). The vestibular, cochlear and facial nerves are contained within the sheath of the dura mater.

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4.0 Temporal Bone CT Images The following CT images very effectively illustrate the osteological details needed for this course

4.1 Axial CT Scans Axial CT sections that include 1 mm cuts with overlap are appropriate for temporal bone visualization. The cuts start from the level of the mastoid tip and continue up to the level of the superior SCC.

Some authors link the anatomical structures with mnemonic cartoon symbols that aid in memorizing the major structures and their characteristics, such as:

Mnemonic symbols

Mnemonic symbols

Anatomical structure

Internal auditory meatus (IAM)

Jugular bulb and inferior petrosal sinus Duck bill

Funnel

Cochlear aqueduct Horn

Incus and malleus Ice cream cone

Basal turn of the cochlea Smile

Attic, aditus, and antrum Hour glass

Cochlea Horns

Carotid artery Inverted L

Vestibular aqueduct

Common crus Slit

Spot

Lateral SCC Bucket handle


Superior SCC Snake eyes


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Try to refresh your knowledge with the axial sections listed below.

Sphenoid sinus

Foramen spinosum Anterior cranial fossa

Great wing of the sphenoid

Squamo-sphenoid suture

Foramen ovale Carotid artery (transverse)

Mandibular condyle

Sphenoid body Carotid artery (vertical)


Inferior petrosal sinus Jugular vein

Sinus plate Mastoid cortex

Posterior cranial fossa

Occipito-mastoid suture Fig. 33

Sphenoid sinus Anterior cranial fossa Great wing of the sphenoid Foramen ovale Foramen spinosum Mandibular condyle

Carotid artery (transverse) Petrous apex

External auditory meatus Sphenoid body

Facial nerve

Jugular vein

Mastoid cortex


Sigmoid sinus

Fig. 34

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Sphenoid sinus Foramen spinosum

Great wing of the sphenoid Foramen ovale

Mandibular condyle

Sphenoid body

Middle ear

Carotid artery (transverse) External auditory meatus

Eustachian tube

Facial nerve

Cochlea Posterior cranial fossa

Sigmoid sinus

Fig. 35

Great wing of the sphenoid

Middle ear

Foramen ovale Mandibular condyle

Carotid artery (transverse)

Tympanic membrane and malleus

Sphenoid body Petrous apex

External auditory meatus Cochlea Facial nerve


Sigmoid sinus

Fig. 36 Notice the basal turn of the cochlea, middle ear and the cochlear aqueduct.


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Foramen rotundum

Carotid artery (transverse)

Middle ear Tympanic membrane and malleus

Round window Cochlea

Facial nerve

Cochlear aqueduct

Sinus tympani

Ampullary end of the posterior semi-circular canal

Posterior semi-circular canal


Fig. 37 Notice the cochlea, posterior SCC, sinus tympani, semi-canal of the tensor tympani muscle, round window, facial nerve, chorda tympani, tympanic membrane, and malleus handle.

Foramen rotundum Semicanal of the tensor tympani muscle Carotid artery (transverse)

Middle ear and auditory ossicles

Cochlea Facial nerve Sinus tympani Posterior cranial fossa Common crus

Fig. 38

32


Middle ear and ossicles

Carotid artery

Anterior and posterior crura of the stapes Malleus Long incus process

Semicanal of the tensor tympani muscle Petrous apex Cochlea

Facial nerve Sinus tympani

Vestibule Posterior cranial fossa

Fig. 39 Notice the long incus process.

Facial nerve

Petrous apex Cochlea

Incudomallear complex

Internal auditory meatus Lateral semicircular canal

Vestibule

Common crus


Vestibular aqueduct

Fig. 40 Notice the stapes, vestibule, common crus, and facial nerve.


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Mid-cranial fossa Greater superficial petrosal nerve

Malleus head

Petrous apex Incus body

Geniculate ganglion Internal auditory meatus

Superior semicircular canal Posterior semicircular canal


Fig. 41 Notice the “ice cream cone” (incus and malleus) ossicular complex, vestibule, lateral SCC, facial nerve, IAM, and attic.

Mid-cranial fossa Greater superficial petrosal nerve

Superior semicircular canal

Petrous apex

Attic Aditus ad antrum

Internal auditory meatus

Antrum Posterior semicircular canal


Fig. 42 Notice the posterior and superior semicircular canals.

34


Superior SCC

Fig. 43 Notice the superior SCC extending to the dome, which is equivalent to the arcuate eminence at the mid-cranial fossa.


35

4.2 Coronal CT Scans A series of 1 mm cuts with overlap are appropriate for temporal bone coronal CT imaging. The cuts start from anterior to posterior from the level of the cochlea back to the level of the posterior SCC.

Some authors link the anatomical structures with mnemonic cartoon symbols that aid in memorizing the major structures and their characteristics, such as:

Mnemonic symbols

Mnemonic symbols

Anatomical structure Superior SCC, lateral SCC, basal turn of cochlean

Three fingers


Scutum Pyramid

Transverse crest IAM

Malleus Hammer

Vestibule and round window Snail eyes

Inverted tear drop

Eustachian tube

Cochlea Snail shell

Labyrinth and tympanic facial nerve segments

Inverted triangle

36


Try to refresh your knowledge with the coronal sections listed below.

Attic

Tegmen tympani Facial nerve, tympanic portion

Facial nerve, labyrinth portion

Middle ear Digastric notch Annulus

Cochlea Petrous apex Petro-occipital joint

Mandibular condyle

Carotid artery Eustachian tube Fig. 44 Notice the cochlea, carotid artery, Eustachian tube, middle ear, attic, digastric notch, tympanomastoid suture, and mandibular condyle.

Tendon of the tensor tympani muscle Malleus

Attic

Tegmen

Cochleariform process

Mastoid air cells Scutum External ear Tympanic membrane

Cochlea Petrous apex Petro-occipital fissure

Annulus

Middle ear

Mandibular condyle

Eustachian tube Fig. 45 Notice the attic, malleus head and neck, tendon of tensor tympani muscle, tympanic membrane, middle and external ear, Eustachian tube, petro-occipital suture, cochlea, mandibular condyle, petrous apex, annulus, scutum, tegmen and cochleariform process.

Attic

Malleus Tegmen Mastoid air cells

Transverse crest Internal auditory meatus

Scutum

Middle ear

External ear

Petrous apex

Tympanic membrane

Petro-occipital Annulus

Mandibular condyle Fig. 46 Notice the internal auditory meatus and transverse crest, attic, malleus, scutum, tegmen, mastoid air cells, external auditory meatus, tympanic membrane, mandibular condyle, annulus, petro-occipital suture, petrous apex and middle ear.


37

Arcuate eminence Superior semicircular canal

Lateral semicircular canal Tegmen tympani

Vestibule Internal auditory meatus

Mastoid air cells Body of incus

Stapes footplate Petrous apex

Scutum

Petro-occipital fissure Basal turn of the cochlea

External ear Tympanic membrane

Middle ear

Incudo-stapedial joint Fig. 47 Notice the internal auditory meatus, basal turn of the cochlea, superior (arcuate eminence) and lateral SCC, tympanic membrane, incus, stapes footplate, tegmen tympani, lateral semicircular canal, mastoid air cells, body of incus, scutum, external ear, incudo-stapedial joint, vestibule, petrous apex, petrooccipital fissure and middle ear.

Tegmen tympani Middle ear

Mastoid air cells

Vestibule

Antrum

Petrous apex

Tympanic membrane

Round window

External ear

Fig. 48 Notice the vestibule, round window, petromastoid suture, hypoglossal canal, and jugular bulb.

Tegmen tympani

Arcuate eminence Superior semicircular canal

Mastoid air cells

Lateral semicircular canal Antrum Jugular vein

Facial nerve (vertical part) Fig. 49 Notice the jugular bulb, hypoglossal canal, mastoid cells, and SCC.

38


Tegmen tympani Superior semicircular canal Lateral semicircular canal Mastoid air cells Posterior semicircular canal Jugular vein Hypoglossal canal Mastoid tip Fig. 50 Notice the posterior SCC, mastoid air cells, jugular bulb, tegmen tympani, mastoid tip, lateral and superior SSCs and hypoglossal canal.


39

5.0 Exposure of the Temporal Bone: Genuine Dissections Cochleostomy Eustachian tube

Superior SCC Lateral SCC

Facial nerve

Solid angle Posterior SCC Digastric ridge Fig. 51

Superior incudal ligament Body of incus Posterior meatal wall Attic Short process of incus Lateral SCC Fossa incudis

Posterior tympanotomy

Fig. 52

40



Tympanic plate Incudostapedial joint

Attic

Annulus

Incus Fossa incudis

Umbo

Antrum

Facial nerve

Superior SCC Lateral SCC Posterior SCC

Fig. 53

Chorda tympani Semicanal of tensor tympani Tympanic membrane Cochleariform process

Tendon of the tensor tympani muscle

Facial nerve Incudostapedial joint

Malleus handle

Superior SCC Head of malleus Lateral SCC Body of incus Short process of incus Fig. 54

Malleus

Anterior wall of external auditory meatus

Incus

Malleus handle Attic Tympanic membrane Lateral SCC Incudostapedial joint Pyramidal process Promontory

Fig. 55


Körner’s septum is an internal extension of the petrosquamous suture. May mislead into a false antrum

41

Antrum

Fig. 56

Oval window Tegmen tympani

Promontory Round window

Facial nerve Superior SCC

Facial nerve

Lateral SCC Jugular bulb

Posterior SCC Sinus plate Fig. 57

42


Remember ☞ ●

When is the right time to begin with training in the operating room?

When both the trainer and trainee are equally satisfied about the outcome. ● When the trainee is able to identify ear structures as if within one’s own bedroom in the dark. ● After watching various live surgeries.

☞

When back to the operating room, never forget

●

Morbid anatomy. Congenital anomalies. ● Continuous polishing of your skills. ●

Remember, that ear surgery is not for amateurs; it can end with unpleasant complications like facial nerve palsy, perilymph fistula and vertigo, fatal intracranial complications or hearing loss.


Dissection Manual for the Temporal Bone Laboratory Instruments, Units, Video Systems and Accessories

43

44


Please note: The temporal bone dissection laboratory should be located away from all clinical and surgical activities with sanitary arrangements managed by the infection control officer of the hospital. The number of stations is subject to the number of participants. The main station should be equipped with a video camera and monitor for demonstration purposes. The lab should be equipped with a large double level refrigerator for storage of the temporal bone specimens.

Checklist: Instruments for the Temporal Bone Dissection Laboratory Each participant and main station: ❑ 123207 HOLMGREEN Endaural Ear Speculum, self-retaining, outer diameter 7 mm ❑ 223803 Seeker, with ball end, angled 45°, size 3, length 15.5 cm ❑ 224001 HOUSE Curette, large, spoon sizes 2.8 x 3.2 mm and 2.6 x 3.5 mm, length 15 cm ❑ 225205 Pick, 90º, length 16 cm, 0.5 mm ❑ 152301 Ear Hook, without ball end, size 1, length 15.5 cm ❑ 212803 LEMPERT Elevator, width 3 mm, length 19 cm ❑ 213008 PLESTER Elevator, width 8 mm, length 18 cm ❑ 208000 Surgical Handle, Fig. 3, length 12.5 cm, for blades 208010 – 19, 208210 – 19 ❑ 208015 Blades, Fig. 15, non-sterile, package of 100 ❑ 203710 Suction Tube, cylindrical, LUER, outer diameter 1 mm, working length 9 cm ❑ 203730 Suction Tube, cylindrical, LUER, outer diameter 3 mm, working length 11 cm ❑ 206500 FISCH Suction and Irrigation Tube, cylindrical, outer diameter of suction tube 3 mm, irrigation tube 2 mm, working length 9.5 cm ❑ 161000 HARTMANN Ear Forceps, alligator type, serrated, working length 8 cm ❑ 223500 ROSEN Elevator, tip angled 15°, 12 mm long, width 1.5 mm, length 16 cm ❑ 280120 Temporal Bone Holder, bowl-shaped, with 3 fixation screws for tensioning the petrosal bone and with evacuation tube for irrigation liquid

Checklist: Powered Instrumentation – UNIDRIVE® ENT Each participant and main station: ❑ 40 7116 01-1 UNIDRIVE® ENT consisting of: 20 7116 20-1 UNIDRIVE® ENT with KARL STORZ-SCB®, power supply 100 – 120, 230 – 240 VAC, 50/60 Hz 400 A Mains Cord 20 0126 30 Two-Pedal Footswitch, two stage, with proportional function 20 7116 40 Silicone Tubing Set, for irrigation, sterilizable 20 7116 21 Clip Set, for use with Tubing Set 20 7116 40 20 0901 70 SCB Connecting Cable, length 100 cm 031131-01* Single Use Tubing Set, sterile, package of 3 ❑ 20 7110 32 High Performance EC Micro Motor ❑ 20 7110 72 Connecting Cable, to connect EC micro motor 20 7110 32 to control unit ❑ 252475 INTRA Drill Handpiece, angled, length 12.5 cm, for use with straight shaft burrs, transmission 1:1 (40,000 rpm) ❑ 260000 Standard Straight Shaft Burr, stainless, sizes 006 – 070, length 7 cm, set of 15 ❑ 262000 Diamond Straight Shaft Burr, stainless, sizes 006 – 070, length 7 cm, set of 15

Checklist : General Equipment for Participants Each participant: ❑ Zeiss Operating Microscope with side tube Main station: Main station operating microscope with: ❑ Camera control unit 20 2130 11 ❑ Camera head 20 2120 34 ❑ TV-Adaptor for ZEISS operating microscope 301677 ❑ Optical Beamsplitter 50/50, for use with Zeiss operating microscope 301513 ❑ C-Mount Microscope Adapter 20220040 and monitor 9415 N Each participant and main station:

❑ Suction and irrigation unit ❑ Gowns ❑ Gloves ❑ Overshoes ❑ Head caps ❑ Fluid soap ❑ Tissues ❑ Disposable syringe


45

Instruments for the Temporal Bone Dissection Laboratory

223803

224001

225205

208015

123207

123207 212803 213008 208000

212803

213008

208000

HOLMGREEN Endaural Ear Speculum, self-retaining, outer diameter 7 mm LEMPERT Elevator, width 3 mm, length 19 cm PLESTER Elevator, width 8 mm, length 18 cm Surgical Handle, Fig. 3, length 12.5 cm, for Blades 208010 – 19, 208210 – 19

223803

208015 223803 224001

225205

224001

225205

Blades, Fig. 15, non-sterile, package of 100 Seeker, with ball end, angled 45°, size 3, length 15.5 cm HOUSE Curette, large, spoon sizes 2.8 x 3.2 mm and 2.6 x 3.5 mm, length 15 cm Pick, 90º, length 16 cm, 0.5 mm

46


Instruments for the Temporal Bone Dissection Laboratory

8c m

161000

223500 152301 161000

203710

152301

11 c m

9 cm

223500

203730

203710

9,5 cm

152301 223500

206500

161000 203710 203730 206500

206500

280120

280120

203730

Ear Hook, without ball end, size 1, length 15.5 cm ROSEN Elevator, tip angled 15°, 12 mm long, width 1.5 mm, length 16 cm HARTMANN Ear Forceps, alligator type, serrated, working length 8 cm Suction Tube, cylindrical, LUER, outer diameter 1 mm, working length 9 cm Suction Tube, cylindrical, LUER, outer diameter 3 mm, working length 11 cm FISCH Suction and Irrigation Tube, cylindrical, outer diameter suction tube 3 mm, geliefertiirrigation tube 2 mm, working length 9.5 cm Temporal Bone Holder, bowl-shaped, with 3 fixation screws for tensioning the petrosal bone and with evacuation tube for irrigation liquid


47

UNIDRIVE® ENT The high-end multifunction system for excellent handling and convenience in the OR

One unit – six functions • Shaver S7ystem for surgery of the paranasal • • • • •

sinuses and anterior skull base Sinus Burr Drill STAMMBERGER-SACHSE Intranasal Drill Micro Saw Dermatome

Special features:

• With touch screen • Color display • Choice between several display languages • Functions displayed in words • Clearly defined operating elements • Set values of the last session are stored • Automatic error message via text display

48


UNIDRIVE® ENT Constant motor speed • Microprocessor-controlled motor speed • Preselected parameters are maintained during drilling • Continuously adjustable speed of rotation • Maximum speed of rotation can be preset Integrated irrigation pump

• Microprocessor-controlled flow rate • Quick and easy connection of the tubing set • Flow rate can be controlled from the sterile area via footswitch • Flow rate adjustable from 6–125 ml/min 2 motor outputs

• Simultaneous connection of 2 motors • Active output can be selected from the sterile area via footswitch

Special features and benefits Saves time

• 2 motors can be connected simultaneously

왘 no plugging or unplugging during the operation

• Automatic display of error messages

왘 no time-consuming error tracing in the operating room • Exact reading and adjustment of motor speed • Preselected parameters can be stored 왘 set-point values for motor speed and flow rate do not need to be readjusted with each new procedure • Quick and easy connection of the tubing set to the pump Relieves OR personnel

• The time for preparation prior to surgery is considerably reduced by standardization • Irrigation flow rate and motor speed adjustable via footswitch • Easy to use due to clearly structured design and optimized function selection • Personnel can use the time saved for other tasks • User can control multiple functions from the sterile area via footswitch Saves money

• Only one unit required to perform six functions • Most of the available shaver blades, burrs and drills are reuseable 왘 enables perfect hygienic reprocessing

• EC micro motor is compatible with various INTRA drill handpieces


49

UNIDRIVE® ENT Technical specifications: Mode

Handpiece No.

Motor speed (max.) rpm

Shaver mode Operation mode: Max. rev. (rpm):

oscillating in conjunction with Micro Shaver Handpiece in conjunction with Paranasal Sinus Shaver Handpiece in conjunction with DrillCut-X Shaver Handpiece

40 7110 35 40 7110 39 40 7110 40

3,000* 7,000* 7,000*

Sinus Burr mode Operation mode: rotating Max. rev. (rpm):

in conjunction with DrillCut-X Shaver Handpiece

Drilling mode Operation mode:

counter-clockwise or clockwise

Max. rev. (rpm):

40 7110 40

12,000

in conjunction with EC Micro Motor and Connecting Cable

20 7110 32 20 7110 72

40,000


20 7110 32 20 7110 72

20,000

20 7110 32 20 7110 72

60,000

20 7110 32 20 7110 72

8,000

Micro Saw mode Max. rev. (rpm):

Intranasal Drill mode Max. rev. (rpm):


Dermatome mode Max. rev. (rpm):


* Approx. 3000 rpm is recommended as this is the most efficient suction/performance ratio.

Power supply:

100-120, 230-240 VAC, 50/60 Hz

Dimensions:

304 x 164 x 263 mm

(w x h x d)

Two outputs for parallel connection of two motors Integrated irrigation pump Flow rate: 6-125 ml/min, adjustable in 8 steps Touch Screen:

6.4" / 300 cd/m2

Weight:

6.1 kg

Certified to:

IEC 60-1 CE acc. to MDD

Selectable display languages:

English, French, German, Spanish, Italian, Portuguese, Greek, Turkish

50


UNIDRIVE® ENT

20 7116 20-1

40 7116 01-1 UNIDRIVE® ENT consisting of: 20 7116 20-1 UNIDRIVE® ENT with KARL STORZ ®, Communication Bus System power supply: 100 – 240 VAC, 50/60 Hz 400 A Mains Cord 20 0126 30 Two-Pedal Footswitch, two-stage, with proportional function 20 7116 40 Silicone Tubing Set, for irrigation, sterilizable 20 7116 21 Clip-Set, for use with tubing set 20 7116 40 20 0901 70 SCB Connecting Cable, length 100 cm 031131-01* Disposable tubing set, sterile

*

mtp medical technical promotion gmbh, Take-Off Gewerbepark 46, D-78579 Neuhausen ob Eck, Germany


UNIDRIVE® ENT

51

Two-Pedal Footswitch

Silicone Tubing Set

System Components

20 7116 40

20 0126 30

UNIDRIVE® ENT U N I T

S I D E

PAT I E N T S I D E

EC Motor with Connecting Cable

STAMMBERGER-CASTELNUOVO DrillCut-X Shaver Handpiece with integrated suction / irrigation channel and longer shaver blade, with connecting cable

20 7110 32 20 7110 72

40 7110 40

Shaver Blade, straight

INTRA Drill Handle

Sinus Burr

254000 - 254300

253000 - 253300

40 7110 35

40201 KN Shaver Blade, curved

41202 KN

660000

Dermatome

40 7110 39 20 7110 70

Shaver Blade, straight

Shaver Blade, curved

Micro Saw

Micro Shaver Handpiece straight, with integrated EC-Micro Motor and Connecting Cable

41201 KN

252475 - 252495 Intranasal Drill

STAMMBERGER, Paranasal Sinus Shaver Handpiece 90° angle, with connecting cable

41305 DN

40302 KN

52


INTRA Drill Handpieces

252475

INTRA Drill Handpiece, angled, length 12.5 cm, for use with straight shaft burrs, transmission 1:1 (40,000 rpm)

252475

Burrs Straight Shaft Burrs, length 7 cm 7 cm

Standard Detail

260000

Tungsten Carbide

Diamond Transverse Diamond, Tungsten for single coarse Carbide use, sterile, sterilizable set of 5

Size

Dia. mm

006

0.6

–

260006

261006

–

–

262006

–

007

0.7

–

260007

–

–

–

262007

–

008

0.8

–

260008

261008

–

–

262008

–

010

1

–

260010

261010

–

–

262010

–

014

1.4

–

260014

261014

261114

–

262014

–

018

1.8

–

260018

261018

–

–

262018

–

023

2.3

260023 D

260023

261023

261123

262023 D

262023

262223

027

2.7

–

260027

261027

–

–

262027

262227

031

3.1

260031 D

260031

261031

261131

262031 D

262031

262231

035

3.5

–

260035

261035

–

–

262035

262235

040

4

260040 D

260040

261040

261140

262040 D

262040

262240

045

4.5

–

260045

261045

–

–

262045

262245

050

5

260050 D

260050

261050

261150

262050 D

262050

262250

060

6

260060 D

260060

261060

261160

262060 D

262060

262260

070

7

–

260070

261070

–

–

262070

262270

for single use, sterile, sterilizable set of 5

Standard Straight Shaft Burr, stainless, sizes 006 – 070, length 7 cm, set of 15

262000

Diamond Straight Shaft Burr, stainless, sizes 006 – 070, length 7 cm, set of 15


TELECAM® SL II

53

n

Camera Heads For use with TELECAM® SL II Camera Control Unit 20 2130 11U

TELECAM® One-Chip Camera Head

20 2120 30 / 20 2121 30

20 2120 30

PAL

20 2121 30

NTSC

TELECAM® One-Chip Camera Head

color systems PAL/NTSC, with integrated Parfocal Zoom Lens, f = 25 – 50 mm (2x), 2 freely programmable camera head buttons

TELECAM® C-MOUNT One-Chip Camera Head 20 2120 34

PAL

20 2121 34

NTSC

TELECAM® C-MOUNT One-Chip Camera Head

color systems PAL/NTSC, 2 freely programmable camera head buttons 20 2120 34 / 20 2121 34

TELECAM® SL II Camera Control Unit

20 2130 20

20 2130 11U TELECAM® SL II Camera Control Unit color systems PAL/NTSC, with integrated digital Image Processing Module consisting of: 20 2130 20 TELECAM® SL II Camera Control Unit 400 A Mains Cord 20 2001 30U Keyboard, with US-english character set 2x 20 2210 70 Connecting Cable, for controlling peripheral devices, length 180 cm 536 MK BNC/BNC Video Cable, length 180 cm 547 S S-Video (Y/C) Connecting Cable, length 180 cm 20 0400 82 DV Cable, 6 pin to 4 pin, length 500 cm

Specifications: Video Output

Input

- Composite signal at BNC socket - S-Video signal to 4 pin Mini DIN socket (2x) - DV signal to 6 pin DV socket

Keyboard input for title generator and camera functions to 5 pin DIN socket

Control Output

Control Unit (CCU)

3.5 mm stereo jack plug - Dimensions: (ACC 1, ACC 2) 305 x 88 x 254 mm (w x h x d) - Weight: 2.7 kg

Power Supply

Certified to:

100-240 VAC, 50/60 Hz

IEC 601-1, 601-2-18, CSA 22.2 No. 601, UL 2601, and CE according to MDD, protection class 1/BF

54


Video Accessories for Operating Microscopes In addition to using the KARL STORZ Endovision® camera systems with endoscopes, all KARL STORZ cameras can be connected to other systems, such as microscopes, colposcopes, and slit lamps. The adaptation requires a standardized C-MOUNT connection on the specific optical system.

This connection can be made both directly via the standardized C-MOUNT connection or indirectly via special quick-adaptors.

Both alternatives have specific advantages: Direct Adaptation

Indirect Adaptation

A direct connection between camera and microscope has the advantage that no special adaptor systems are necessary any longer. The direct C-MOUNT connection is safe, stable, and does not reduce quality. Such a connection can be made, for example, with the TELECAM® C-MOUNT Camera Head 20 2120 34/20 2121 34 or the TRICAM® C-MOUNT Camera Head 20 2210 34/ 20 2211 34 in conjunction with a C-MOUNT microscope adaptor.

An indirect adaptation between the KARL STORZ Endovision® camera systems and other optical systems, for example, a microscope or colposcope with CMOUNT connection, may be accomplished with special quick-adaptors. These quick-adaptors ensure the connection between the standardized endoscope coupling and the C-MOUNT of the optical system. The advantage of this solution is that the camera can be plugged directly into the optical system with the endoscope coupling, without time-consuming threading action. Such a quick-adaptation is possible with all KARL STORZ Endovision® cameras.

Example for direct C-MOUNT adaption: KARL STORZ Endovision® TELECAM® Microscope Camera Head


55

Video Accessories for Operating Microscopes Adaptor for Direct and Indirect C-MOUNT Adaptation

Camera Heads for quick coupling of Endovision® camera with C-MOUNT Adaptor 2010 Z: Indirect C-MOUNT Adaptation

Camera Heads for use with TV Adaptor 301677: Direct C-MOUNT Adaptation

20 2120 30 20 2121 30

20 2120 34 20 2121 34

20 2200 40 C-MOUNT Microscope Adaptor 301513 2010 Z

2010 Z

301513

C-MOUNT Adaptor, allows quick coupling of Endovision® camera e. g. with operating microscopes (the camera’s coupling device is mounted on the 2010 Z adaptor which fits to an operating microscope’s C-MOUNT ring) Optical Beamsplitter 50/50, for use with ZEISS operating microscope or colposcope

301677

301677

TV-Adaptor, for ZEISS operating microscope or colposcope, f = 85 mm, for use with Optical Beamsplitter 301513 and C-MOUNT Adaptor 2010 Z or TELECAM® C-MOUNT One-Chip Camera Head 20 2120 34/20 2121 34 20 2200 40 C-Mount Microscope Adaptor for use with KARL STORZ Endovision TRICAM® C Camera Head 20 2210 34/20 2211 34

56


The Compact Documentation Solution KARL STORZ AIDA™ compact II combines all the required functions for integrated and precise documentation of endoscopic procedures and open surgeries in a single system. Data Acquisition AIDA compact II records still images, video sequences and spoken comments of findings and intraoperative procedures directly from the sterile area. Recordings are activated via touch screen, voice control, footswitch or camera head buttons. Live display of camera images on the touch screen enables immediate monitoring and selection of the recorded data. AIDA compact II: Voice control

Flexible Review Before final archiving, the saved data can be viewed or listened to on the review screen. Data no longer required can be simply deleted.

AIDA compact II: Review screen

Individual images, video and audio sequences can be renamed and given more meaningful names. A pre-defined selection list with keywords simplifies and speeds up data entry. Furthermore, a comment field is available for entering relevant details of an intervention. A voice entry of the case report can yet be recorded while viewing video and image files.

Automated Data Archiving Once a treatment is completed, AIDA compact II automatically stores the data on a DVD or CD-ROM, creates a standard report and prints it as an overview if required. AIDA compact II: Automatic creation of standard reports

Multisession and Multipatient Efficient data archiving is assured as several treatments can be saved on one DVD, CD-ROM or on an USB stick.

AIDA compact II: Efficient archiving


57

Special Features: ● Digital storage of still images, video sequences and audio files ● Digital alternative to video printer, video recorder and dictating machine ● Sterile, ergonomic operation via touch screen, voice control, camera head buttons and/or footswitch ● Efficient archiving on DVD, CD-ROM or USB stick, multisession and multipatient ● Network storage is possible ● Optional connection to PACS, RIS and HIS ● Automatic creation of standard reports ● Computers and monitors for use in the OR area certified according to EN 60601-1 ● Compatible with KARL STORZ Communication Bus (SCB) and OR1™ connect series

20 0406 01U KARL STORZ AIDA™ compact II System Documentation system for digital archiving of image, video and audio files in the OR, power supply: 100/240 VAC, 50/60 Hz consisting of: 20 0960 20 KARL STORZ AIDA™ control, with integrated DVD/CD writer 20 0403 77 Frame Grabber Board, with digital I/Os 20 0403 78 Slot Bracket, for digital I/Os 20 0902 34U PS/2 Compact Keyboard, US version, with cover 20 0404 02-12 KARL STORZ AIDATM compact II Software, with voice control and software protection 20 0402 75 KARL STORZ USB Stick, 512 MB 2 x 20 2210 70 Connecting Cable 20 0901 38 Headset 20 0903 76 Headset Extension Cable, length 10 m 547 S S-Video (Y/C) Connecting Cable, length 180 cm 400 A Mains Cord 400 B Mains Cord, US version Specifications: Video Systems ● ●

PAL NTSC

Signal Inputs ● ●

S-Video (Y/C) Composite

Image Formats

Video Formats

Audio Formats

Storage Media

● ●

● ● ●

●

● ● ● ● ● ● ●

JPG BMP

MJPEG MPEG1 MPEG2

WAV

DVD+R DVD+RW DVD-R DVD-RW CD-R CD-RW USB Stick

58


KARL STORZ ENDOVISION TRICAM® SL II with

®

– autoclavable

Digital Three-Chip Video Camera – Color Systems PAL, NTSC 20 2210 40

KARL STORZ Endovision TRICAM®, three-chip camera, color system PAL, with integrated Parfocal Zoom Lens, f = 14 mm – 28 mm, (2x); with 2 freely programmable buttons, camera head autoclavable, including sterilisation tray 39301 ACT.

20 2211 40

KARL STORZ Endovision TRICAM®, three-chip camera, color system NTSC, with integrated Parfocal Zoom Lens, f = 14 mm – 28 mm, (2x); with 2 freely programmable buttons, camera head autoclavable, including sterilisation tray 39301 ACT.

Camera Control Unit 20 223011U1 TRICAM® SL II Camera Control Unit color system PAL/NTSC, with integrated KARL STORZ ® and integrated Image Communication Bus System Processing Module; power supply: 100–240 VAC, 50/60 Hz; set, ready for use; without camera head

KARL STORZ ENDOVISION TELECAM® SL II – autoclavable Digital 1-Chip Video Camera – Color Systems PAL, NTSC 20 2120 40

KARL STORZ Endovision TELECAM®, one-chip camera, color system PAL, with integrated Parfocal Zoom Lens, f = 14 mm – 28 mm, (2x); with 2 freely programmable buttons, camera head autoclavable, including sterilisation tray 39301 ACT

20 2121 40

KARL STORZ Endovision TELECAM®, one-chip camera, color system NTSC, with integrated Parfocal Zoom Lens, f = 14 mm – 28 mm, (2x); with 2 freely programmable buttons, camera head autoclavable, including sterilisation tray 39301 ACT

Camera Control Unit 20 2130 11U TELECAM® SL II Camera Control Unit, color system PAL/NTSC, with integrated Image Processing Module; power supply: 100–240 VAC, 50/60 Hz; set, ready for use; without camera head

20 2000 32

KARL STORZ Special Beamsplitter, for use with IMAGE1™, TRICAM® and TELECAM® camera heads, for simultaneous viewing by endoscope and monitor screen. The camera head connector is 120º deflected and can instantly be swiveled to the desired position.


KARL STORZ

TM

59

DVD-M with SmartscreenTM

Advanced Image and Data Archieving System

Special Features: ● Digital storage of still images, video sequences and audio files ● Digital alternative to video printers, video recorders and dictaphone ● Easy and intuitive handling via touch screen, camera head buttons or footswitch ● Compact design ● Efficient archiving on DVD-R, DVD+R, CD-R, USB Stick, multisession and multipatient

● ● ● ● ●

SDI, S-video (Y/C) and composite video inputs Network storage is possible All video signals are through-patchable to the video monitor Print-out of still images via ink jet printer possible Compatible with KARL STORZ Communication Bus (SCB) and OR1™ connect series

20 2045 01-140 KARL STORZ AIDA™ DVD-M with SmartscreenTM, color system: PAL, NTSC power supply: 100–240 VAC, 50/60 Hz consisting of: 20 2045 20-140 KARL STORZ AIDA™ DVD-M, with integrated DVD/CD writer and integrated touch screen 400 A Mains Cord 400 B Mains Cord, US version 536 MK BNC/BNC Video Cable, length 180 cm 547 S S-Video (Y/C) Connecting Cable, length 180 cm 2 x 20 0400 83 Adaptor, BNC–Cinch 20 0400 84 Serial Connecting Cable, length 20 cm 20 0400 85 DVI Connecting Cable, length 20 cm 20 0400 88 USB-Extension Cable, length 7.5 cm

60


Cold Light Fountains and Accessories

495 NL

Fiber Optic Light Cable, diameter 3.5 mm, length 180 cm

495 NA

Same, length 230 cm

495 ND

Same, length 300 cm

Cold Light Fountain HALOGEN 250 twin

20 1133 01 Cold Light Fountain HALOGEN 250 twin, power supply: 100/120/230/240 VAC, 50/60 Hz, consisting of: 400 A Mains Cord

Cold Light Fountain XENON NOVA® 175 20 134001

Cold Light Fountain XENON NOVA® 175 power supply: 100 –125 VAC / 220 – 240 VAC, 50/60 Hz consisting of: 400 A Mains Cord

20 1320 26 Xenon-Spare-Lamp, only, 175 watt, 15 volt


61

TFT-Flat Screen Monitors Multinorm Liquid Crystal Display, PAL and NTSC with automatic switch-over

9415 NN / 9419 NN

9415 NNB / 9419 NNB

Mobile Videocart

9415 NNB 15" KARL STORZ TFT Flat Screen, Wall-mounted with VESA 100 mounting, color systems PAL/NTSC, resolution max. 1024 x 768, video inputs: (XGA), SDI, Composite, S-Video, RGBS/VGA, brightness 430 cd/m2, contrast 500:1, power supply 100 – 240 VAC, 50/60 Hz consisting of: 9415 NNG 15" TFT Flat Screen 9419 PS External 24 VDC Power Supply 400 A Mains Cord 2x 536 MP BNC/BNC Video Cable, length 240 cm 547 SL S-Video (Y/C) Connecting Cable, length 350 cm 20 0403 72 SVGA Connecting Cable, length 200 cm Instructions for use on CD-ROM 9415 NN Same, desktop model, with pedestal 9419 NNB 19" KARL STORZ TFT Flat Screen EndoVue Desktop, color systems PAL/NTSC, resolution max. 1280 x 1024 (SXGA), video inputs: SDI, Composite, S-Video and RGBS/VGA, brightness 450 cd/m2, contrast 650:1, power supply 100 – 240 VAC, 50/60 Hz consisting of: 9419 NNG 19" TFT Flat Screen 9419 PS External 24VDC Power Supply 400 A Mains Cord 2x 536 MP BNC/BNC Video Cable, length 240 cm 547 SL S-Video (Y/C) Connecting Cable, length 350 cm 20 0403 72 SVGA Connecting Cable, length 200 cm Instructions for use on CD-ROM 9419 NN Same, desktop model, with pedestal

29003 NA

29003 NA

Mobile Videocart, consisting of: 29003 NAG Basic Mobile Cart, rides on 4 antistatic double-casters, 2 equipped with locking brakes, 1 shelf fixed, 1 shelf with mains switch, 1 shelf inclinable, 1 drawer unit with lock, 1 push bar, with large lumen cable channels integrated in both columns, 1 set of non-sliding stands, 1 camera mount 29003 PB Power Box with electrical supply terminal strip with 12 plugs, 12 equipotential plugs Dimensions: Mobile Cart: 700 mm x 1280 mm x 686 mm (w x h x d) shelf: 630 mm x 480 mm (w x d) caster diameter: 125 mm

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