Fehler und Gefahren: Ohrchirurgie und Chirurgie der lateralen Schädelbasis

Zusammenfassung

Die Chirurgie des Ohres und der lateralen Schädelbasis ist ein faszinierendes und anspruchsvolles Gebiet der HNO-Heilkunde. Für den Chirurgen ist ein umfassendes Verständnis der immanenten Gefahren und Komplikationen unverzichtbar: zum einem, um seinen Patienten die bestmögliche Behandlung anzubieten, zum anderen, um seine chirurgischen Fähig- und Fertigkeiten stetig weiter zu entwickeln.

Der vorliegende Artikel fasst zunächst allgemeine Aspekte zur prä-, intra- und postoperativen Versorgung von Patienten mit Erkrankungen des Ohres/der lateralen Schädelbasis zusammen. Anschließend werden die häufigsten Gefahren und Komplikationen auf den Gebieten der Stapeschirurgie, Cochlea-Implantation sowie der Chirurgie von Vestibularisschwannomen und jugulotympanalen Paragangliomen dargelegt. Anhand dieser exemplarischen Operationen werden generelle Grundzüge der lateralen Schädelbasischirurgie erläutert, welche der Leser auch auf andere Krankheitsbilder übertragen kann. Besonderes Augenmerk wurde dabei auf funktionelle Aspekte, wie Hören, Gleichgewicht und die Funktion des Gesichtsnerven gelegt. Des Weiteren kommen Themen wie Infektion, Blutung, Schädelbasisdefekte, Lebensqualität und Indikationsstellung zu Revisionsoperationen zur Sprache.

Der offene Austausch zwischen Chirurgen über Gefahren und Komplikationen der Chirurgie des Ohres/der lateralen Schädelbasis ist die Voraussetzung für die stete Weiterentwicklung dieses faszinierenden Gebietes der Kopf- und Halschirurgie. Dieser Artikel möchte hierfür einen Beitrag leisten.

Abstract

Complications and Pitfalls in Surgery of the Ear/Lateral Skull Base

Surgery of the ear and the lateral skull base is a fascinating, yet challenging field in otorhinolaryngology. A thorough knowledge of the associated complications and pitfalls is indispensable for the surgeon, not only to provide the best possible care to his patients, but also to further improve his surgical skills.

Following a summary about general aspects in pre-, intra- and postoperative care of patients with disorders of the ear/lateral skull base, this article covers the most common pitfalls and complications in stapes surgery, cochlear implantation, surgery of vestibular schwannomas, and jugulotympanal paragangliomas. Based on these exemplary procedures, basic “do’s and don’ts” of skull base surgery are explained, which the reader can easily transfer to other disorders. Special emphasis is laid on functional aspects, such as hearing, balance and facial nerve function. Furthermore, the topics of infection, bleeding, skull base defects, quality of life and indication for revision surgery are discussed.

An open communication about complications and pitfalls in ear/lateral skull base surgery among surgeons is a prerequisite for the further advancement of this fascinating field in ENT surgery. This article is meant to be a contribution to this process.

Schlüsselwörter

Stapeschirurgie - Cochlea-Implantat - Vestibularisschwannom - jugulotympanales Paragangliom - laterale Schädelbasis

Key words

stapes surgery - cochlear implant - vestibular schwannoma - jugulotympanal paraganglioma - lateral skull base

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