First an incision is made behind the left ear.

The muscles are detached and retracted away from the operating site.

The neurosurgeon cuts a small hole in the skull with a Midas Rex drill.

A foot is then attached to the Midas Rex. The foot is inserted through the hole, and pulled back against the inside of the skull. This prevents the drill from cutting too deep. The drill is then used to cut out an oval section about the size of a silver dollar.

The brain is wrapped in three layers of linings, called the meninges. The outer layer, which follows the shape of the inside of the skull, is called the dura matter. The inner layer, which follows the shape of the brain, is called the pia matter. Between these is a fibrous layer which called the arachnoid because it resembles cobwebs when cut.

The neurosurgeon cuts through the dura matter and the arachnoid, and retracts them to expose the brain. Then he retracts the brain to expose the tumor.

Now the neurotologist goes to work. The tumor is examined and the location of the nerves determined. The tumor is debulked.

As each portion of the tumor is removed, the neurotologist must cauterize the blood vessels leading to that part of the tumor.

When enough of the tumor has been removed, the opening of the internal auditory canal (IAC) is exposed. The neurotologist uses the Midas Rex drill to cut away the rear portion of the IAC to expose the portion of the tumor within. This is a very delicate operation, because if the bit bites too deep, it will cut through the nerves within the IAC.

The neurotologist then gently peels the tumor away from the nerves in the IAC.

The facial nerve is located on the surface of the tumor with a facial nerve monitor, and the tumor capsule is peeled off.

The remaining blood vessels are cauterized, and the tumor is cut away from any remaining attachments and is then removed.

The bone around the ear is commonly hollow. These hollow pockets, which are similar to sinuses, are connected to volume around the middle ear. As the neurotologist drills out the bone around the IAC, these hollow pockets are often opened. To prevent the fluids around the brain from leaking out, the neurotologist must plug these openings. For my surgery, the neurotologist used a tiny piece of tissue from the neck, held in place with fibrin glue.

The neurosurgeon goes back to work. First the retraction on the brain is removed. Gelfoam, a material that is absorbed by the body, is placed between the dura and the brain. The dura is losey stitched together, and more gelfoam placed between the dura and the skull.

The piece of bone removed above is replaced, and fastened in place with titanium screws and a titanium plate.

The retraction of the neck tissues is removed, and the muscles reattached to the skull. Finally, the skin is closed with staples and covered with a bandage.