Middle Cranial Fossa Approach: Anatomical Study on Skull Base Triangles as a Landmark for a Safe Anterior Petrosectomy

2019 ◽  
Author(s):  
Pasquale Anania ◽  
Rosa Mirapeix-Lucas ◽  
Gianluigi Zona ◽  
Alessandro Prior ◽  
Carlos Asencio Cortes ◽  
...  
Keyword(s):  
Anatomical Study ◽  
Middle Cranial Fossa ◽  
Gasserian Ganglion ◽  
Anatomical Landmarks ◽  
Basal Turn ◽  
Caucasian Race ◽  
Iatrogenic Damage ◽  
Anterior Petrosectomy ◽  
Cranial Fossa ◽  
Hearing Damage

Abstract Objective The Kawase approach provides access to the petroclival and posterior cavernous sinus regions, cerebellopontine angle, and upper basilar artery territory. Nevertheless, it remains one of the most challenging approach for neurosurgeons, due to the considerable related morbidity and mortality. The goal of this study was to evaluate the relationship between anatomical landmarks and their possible variations, and to measure the extension of the Kawase space, to define the reliability of these landmarks while performing an anterior petrosectomy. Design Using eight cadaveric specimens (15 sides), an anatomical dissections and extradural exposure of the Kawase area were performed. Settings A two-step analysis of the distances between the mandibular branch of the trigeminal nerve (V3) and the structures at risk of iatrogenic damage was performed. Main outcome measures We measured the distance between V3 and the basal turn of the cochlea, and between V3 and the internal acoustic canal (IAC), analyzing the limits of bone resection without causing hearing damage. Results We analyzed eight cadaveric (15 sides) formalin-fixed heads injected with colored silicone: four males and four females of Caucasian race (mean age: 73.83 years). We found a mean distance of 10.46 ± 1.13 mm between the great superficial petrous nerve (GSPN) intersection with V3 and the basal turn of the cochlea, and of 11.92 ± 1.71 mm between the origin point of V3 from the Gasserian ganglion and the fundus of the IAC. Conclusion The knowledge of the safe distance between the most applicable anatomic landmarks and the hearing structures is a practical and useful method to perform this approach reducing related comorbidity.

Endoscopic Transorbital Approaches to Anterior and Middle Cranial Fossa: A Laboratory Investigation on Surgical Anatomy and Potential Routes

2020 ◽  
Author(s):  
Beniamino A. Nannavecchia ◽  
Mario Ganau ◽  
Hélène Cebula ◽  
Antonino Scibilia ◽  
Maria T. Bozzi ◽  
...  
Keyword(s):  
Anatomical Study ◽  
Middle Cranial Fossa ◽  
Surgical Anatomy ◽  
Anatomical Landmarks ◽  
Orbital Cavity ◽  
New Horizons ◽  
Endoscopic Transorbital ◽  
Cranial Fossa ◽  
Alternative Routes ◽  
Anatomy Knowledge

Abstract Background Transorbital neuroendoscopic (TONES) approaches promise to open up new horizons for skull base surgery, offering alternative routes to reach the anterior and middle cranial fossa (ACF and MCF, respectively). Objective The aim of this anatomical study is to acquire new surgical anatomy knowledge and exploit it for the refinement of TONES approaches, as an alternative to open surgery, to reduce the distance to the target, and the risk of neurovascular lesions in pathological conditions extending beyond the orbital cavity. Materials and Methods Six head specimens (12 orbits) were studied/dissected. The orbit was approached and divided in a four clockwise quadrants manner to simulate three transconjunctival routes: the precaruncular (PC), preseptal (PS), and lateral retrocanthal (LRC), and one transpalpebral route—the superior eyelid crease (SLC). The boundaries and the most important anatomical landmarks were identified and are herein duly detailed with particular attention to the neurovascular structures encountered in each of those routes. Results The dissections showed that the PC approach facilitates the treatment of optic nerve and frontal sinus pathologies, whereas LRC appears safer to reach ACF and MCF allowing for a free multiplanar working channel (up to 180 degrees) to the floor, roof, and lateral-to-medial walls. Conclusion The plane of tendon lateral canthal's insertion and the sphenofrontal suture (SFS) were identified as the key anatomical landmarks for TONES approaches. Further studies are warranted to establish a practical clinical algorithm based on the anatomical four clockwise quadrants herein implemented/proposed, and the key surgical landmarks identified.

scholarly journals MORPHOMETRIC CHARACTERISTICS OF THE LONGITUDINAL PARAMETERS OF THE MIDDLE CRANIAL FOSSA OF ADULTS DEPENDING ON EXTREME TYPE OF SKULLS STRUCTURE

10.23856/4333 ◽  
2021 ◽  
Vol 43 (6) ◽  
pp. 256-262
Author(s):  
Iryna Chekanova
Keyword(s):  
Short Form ◽  
Middle Cranial Fossa ◽  
Anatomical Landmarks ◽  
Detailed Understanding ◽  
Extreme Type ◽  
Complex Anatomy ◽  
Cranial Fossa ◽  
Human Skulls ◽  
The Individual ◽  
Base Of The Skull

Surgical accesses through the middle cranial fossa (MCF) and their variations require the surgeons a detailed understanding of a complex anatomy of this site of the inner base of the skull (IBS) and an individual anatomical variability of the anatomical landmarks often used in their medical practice. The aim of this study is to establish individual anatomical variability of the longitudinal dimensions of MCF of mature age human. The research was carried out by studying 50 craniotomograms and 50 bone preparations of mature age human skulls with their further subdivision to extreme types of skulls groups. The examinations of the main longitudinal parameters were done for detailed MCF craniometry, namely: MCF lateral cranial length, MCF general length, MCF medial areas length. It was determined that all longitudinal dimensions increase from brachicephales to dolichocephales. This is due to the fact that for brachicrans (round-headedness) short form of the skull is inherent, for dolichocrans (narrow-headedness) – long and for mesocrans (moderate-headedness) average head size is inherent. According to the received data, MCF longitudinal parameters of mature age human regardless of the extreme types of the skull structure have the tendency to increase from medial sections of the investigated area to lateral. The results of this study substantially complete the existing information about the individual anatomical variability of MCF of mature age human and also make it possible to deeply use this data in practical medicine and for further research in morphology and in craniology in details.

Distance from the Labyrinthine Portion of the Facial Nerve to the Basal Turn of the Cochlea Temporal Bone Histopathologic Study

1996 ◽  
Vol 105 (4) ◽  
pp. 323-326 ◽  
Author(s):  
Miriam I. Redleaf ◽  
Richard R. Blough
Keyword(s):  
Facial Nerve ◽  
Internal Auditory Canal ◽  
Middle Cranial Fossa ◽  
Geniculate Ganglion ◽  
Cochlear Function ◽  
Standard Size ◽  
Basal Turn ◽  
History Of ◽  
Cranial Fossa ◽  
Temporal Bones

The middle cranial fossa approach to lesions of the geniculate ganglion and internal auditory canal preserves cochlear function and affords access to the lateral internal auditory canal. The labyrinthine portion of the facial nerve tends to course near the basal turn of the cochlea, just beneath the middle cranial fossa floor, and is usually dissected in this approach. To determine the distance from the labyrinthine portion of the facial nerve to the basal turn of the cochlea, measurements were obtained in the temporal bones of 24 subjects (48 ears) 9 to 76 years of age. These subjects had no history of facial nerve or ear disease, and had normal audiograms. The distances ranged from 0.06 to 0.80 mm, with 21 of 24 right ears (87.5%) showing distances less than the standard size of the smallest diamond drills (0.6 mm), and 18 of 24 (75%) less than 0.5 mm. Incidental note is made of the distance from the geniculate ganglion to the ampulla of the superior semicircular canal, which ranged from 2.06 to 4.88 mm in the 48 specimens. These measurements can serve as guidelines for the surgeon working in the middle cranial fossa.

Adenoid Cystic Carcinoma with Intracranial Extension: Report of Three Cases

Neurosurgery ◽  
1990 ◽  
Vol 26 (6) ◽  
pp. 1060-1065 ◽  
Author(s):  
Shinichiro Wakisaka ◽  
Akitsugu Nonaka ◽  
Yoshihiro Morita ◽  
Masashi Fukui ◽  
Kazuo Kinoshita
Keyword(s):  
Radiation Therapy ◽  
Adenoid Cystic Carcinoma ◽  
Residual Tumor ◽  
Middle Cranial Fossa ◽  
Intracranial Extension ◽  
Gasserian Ganglion ◽  
The Third ◽  
Orbital Roof ◽  
Adenoid Cystic ◽  
Cranial Fossa

Abstract Adenoid cystic carcinoma (cylindroma) usually arises from the salivary, lacrimal, or other exocrine glands, and is rarely encountered by neurosurgeons. The authors describe three cases involving intracranial extension. An intraorbital tumor in a 71-year-old man extended directly into the epidural space of the frontal base and destroyed the orbital roof. In a 53-year-old woman, the tumor arose from the area adjacent to the eustachian tube and invaded the Gasserian ganglion. In the third patient, a 58-year-old man, the tumor originated in the maxillary sinus and extended directly into the middle cranial fossa. In all these cases, the tumors were removed to the fullest extent possible. Although residual tumor was markedly reduced by radiation therapy, recurrence and metastases occurred within a few years. Thus, adenoid cystic carcinoma appears to be radiosensitive, but not curable by irradiation. In treating a recurrent tumor in one patient, we applied the so-called “two-route” chemotherapy (cisplatin and its antidote) in combination with radiation therapy. The tumor responded well to this therapy, although multiple pulmonary and bone metastases eventually led to the patient's death.

scholarly journals Morphometry relevant to Anterior Petrosectomy with special reference to Kawase’s Triangle

2017 ◽  
Vol 06 (04) ◽  
pp. 280-285
Author(s):  
Abu Ubaida Siddiqui ◽  
Bikash Chandra Satapathy ◽  
Sukhjeet Singh Gill
Keyword(s):  
Holistic Approach ◽  
Middle Cranial Fossa ◽  
Petrous Apex ◽  
Morphometric Study ◽  
Physiological Status ◽  
Anatomical Landmarks ◽  
Safe Procedure ◽  
Methodical Approach ◽  
Anterior Petrosectomy ◽  
The Individual

Abstract Background and aims :The petrous apex and the middle cranial fossa is a commonly explored area in neurosurgeries and hence require a holistic approach which should include the possibility of anatomical variants and morphometric dissimilarities. Material and Methods:This morphometric study was undertaken on 91 dry adult skulls [182 petrosal apices] to analyze a number of parameters relevant to Anterior Petrosectomy [AP] via the Kawase’s Triangle [KT]. The anatomical landmarks most pertinent to Anterior Petrosectomy [Kawase's approach] were defined, recorded and validated. The findings of the study were compared with earlier workers who have employed other means of investigation viz. dry bones/CT scans or cadaveric studies . Results : The parameters undertaken for the study presented with variable values and moresoever for the surface area of the KT. This can be very logically attributed to the variant anatomy amongst races and also to the physiological status of the individual Conclusions : AP has evolved as a preferred method for approaching petroclival region and thus requires an in depth understanding. The present analysis throws significant light on certain parameters that would be helpful in making anterior petrosectomy safer. Surgeries of the skull base demand for high end precision and proficiency and thus our findings provide enhanced alertness for a better and safe procedure. A methodical approach to the area with the background knowledge of these parameters shall culminate in desired neurosurgical outcomes.

scholarly journals Cochlear implantation trough the middle cranial fossa: a novel approach to access the basal turn of the cochlea

2013 ◽  
Vol 79 (2) ◽  
pp. 158-162 ◽  
Author(s):  
Aline Gomes Bittencourt ◽  
Robinson Koji Tsuji ◽  
João Paulo Ratto Tempestini ◽  
Alfredo Luiz Jacomo ◽  
Ricardo Ferreira Bento ◽  
...  
Keyword(s):  
Cochlear Implantation ◽  
Middle Cranial Fossa ◽  
Basal Turn ◽  
Novel Approach ◽  
Cranial Fossa
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