Blood Supply of the Facial Nerve in the Middle Fossa: The Petrosal Artery

2008 ◽  
Vol 62 (suppl_5) ◽  
pp. ONS297-ONS304 ◽  
Author(s):  
Hatem El-Khouly ◽  
Juan Fernandez-Miranda ◽  
Albert L. Rhoton
Keyword(s):  
Facial Nerve ◽  
Middle Cranial Fossa ◽  
Middle Meningeal Artery ◽  
Sole Source ◽  
Geniculate Ganglion ◽  
Nerve Supply ◽  
Middle Fossa ◽  
Greater Petrosal Nerve ◽  
Cranial Fossa ◽  
Meningeal Artery

Abstract Objective: To define the arterial supply to the facial nerve that crosses the floor of the middle cranial fossa. Methods: Twenty-five middle fossae from adult cadaveric-injected specimens were examined under 3 to 40× magnification. Results: The petrosal branch of the middle meningeal artery is the sole source of supply that crossed the floor of the middle fossa to irrigate the facial nerve. The petrosal artery usually arises from the first 10-mm segment of the middle meningeal artery after it passes through the foramen spinosum, but it can arise within or just below the foramen spinosum. The petrosal artery is commonly partially or completely hidden in the bone below the middle fossa floor. It most commonly reaches the facial nerve by passing through the bone enclosing the geniculate ganglion and tympanic segment of the nerve and less commonly by passing through the hiatus of the greater petrosal nerve. The petrosal artery frequently gives rise to a branch to the trigeminal nerve. The middle meningeal artery was absent in one of the 25 middle fossae, and a petrosal artery could not be identified in four middle fossae. The petrosal arteries were divided into three types based on their pattern of supply to the facial nerve. Conclusion: The petrosal artery is at risk of being damaged during procedures in which the dura is elevated from the floor of the middle fossa, the middle fossa floor is drilled, or the middle meningeal artery is embolized or sacrificed. Several recommendations are offered to avoid damaging the facial nerve supply while performing such interventions.

The Course of the Lesser Petrosal Nerve on the Middle Cranial Fossa

2007 ◽  
Vol 61 (suppl_3) ◽  
pp. ONS-15-ONS-23 ◽  
Author(s):  
Yukinari Kakizawa ◽  
Hiroshi Abe ◽  
Yutaka Fukushima ◽  
Kazuhiro Hongo ◽  
Hatem El-Khouly ◽  
...  
Keyword(s):  
Skull Base ◽  
Middle Cranial Fossa ◽  
Surgical Approaches ◽  
Geniculate Ganglion ◽  
Middle Fossa ◽  
Greater Petrosal Nerve ◽  
Three Bundles ◽  
Thin Bone ◽  
Cranial Fossa

Abstract Objective: The course of the lesser petrosal nerve is not well understood and may be confused with the course of the greater petrosal nerve during middle fossa surgery. The objective was to examine the course of the lesser petrosal nerve along the floor of the middle cranial fossa from the region of the geniculate ganglion to its outlet from the skull base. There are no studies focused on the course of this nerve in relationship to the floor of the middle cranial fossa. Methods: Twenty middle fossae from adult cadaveric specimens were examined using 3 to 40× magnification. Results: The lesser petrosal nerve was partially exposed on the floor of the middle fossa without drilling in 75% of the middle fossae and totally covered by thin bone in 25%. It crossed the floor anterior to the greater petrosal nerve and exited the middle fossa through the canaliculus innominatus in 14 cases, foramen spinosum in 3 cases, and the sphenopetrosal suture in 3 cases. The course of the lesser petrosal nerve has been shown in textbooks to be parallel to the greater petrosal nerve. However, the lesser and greater petrosal nerves diverged in the area medial to the geniculate ganglion in 90% of middle fossae with the angle of divergence averaging 11.6 degrees. The course of the lesser petrosal nerve was divided into three patterns based on the site of confluence of the three bundles of fibers forming the nerve. Conclusion: The relationships of the lesser petrosal nerve in the middle cranial fossa have been described. An understanding of these relationships will reduce the likelihood of it being confused with the greater petrosal nerve during surgical approaches to the middle fossa.

Intraspinosum Middle Meningeal Artery Ligation: A Simple Technique to Control Bleeding in the Middle Fossa During the Anterior Transpetrosal Approach

2017 ◽  
Vol 13 (2) ◽  
pp. 163-172
Author(s):  
Shunsuke Shibao ◽  
Hamid Borghei-Razavi ◽  
Kazunari Yoshida
Keyword(s):  
Facial Nerve ◽  
Histological Study ◽  
Middle Meningeal Artery ◽  
Mandibular Nerve ◽  
Petrous Apex ◽  
Middle Fossa ◽  
Foramen Ovale ◽  
Anterior Transpetrosal Approach ◽  
Nerve Paresis ◽  
Meningeal Artery

Abstract BACKGROUND: Although the greater superficial petrosal nerve (GSPN) is an important landmark of the anterior transpetrosal approach (ATPA), bleeding from the interdural space around the foramen spinosum (FS), the GSPN, and the foramen ovale impedes the identification of the GSPN, during epidural dissection in the ATPA. OBJECTIVE: To describe the technique of intraspinosum middle meningeal artery (MMA) ligation, which enables us to control bleeding from the interdural space. METHODS: During epidural dissection, we identified the FS and partially drilled the lateral side of the FS. Next, we cut the convergence site of the neurovascular structures such as the MMA, middle meningeal vein, and the meningeal branch of the mandibular nerve with the periosteal dura within the FS and continued dural detachment epidurally to expose the petrous apex. Bleeding control around the FS and postoperative facial nerve paresis were assessed for 96 patients treated with the ATPA. Additionally, histological study was performed around the FS using Masson's trichrome stain. RESULTS: In all cases, in which this technique was used, bleeding from the interdural space was well controlled and no persistent facial nerve paresis was identified. In the histological study, we confirmed that the MMA, the middle meningeal vein, and the meningeal branch of the mandibular nerve converged into the FS and many venous channels existed in the interdural space around the FS and the foramen ovale. CONCLUSION: Intra-FS MMA ligation is an effective method for control of bleeding from the interdural space of the middle fossa during the ATPA.

scholarly journals Middle Fossa Approach for Resection of an Intracanalicular Vestibular Schwannoma

2019 ◽  
Vol 80 (S 03) ◽  
pp. S287-S287
Author(s):  
Walter C. Jean ◽  
Kyle Mueller ◽  
H. Jeffrey Kim
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Middle Cranial Fossa ◽  
Petrous Bone ◽  
Middle Fossa ◽  
Middle Fossa Approach ◽  
Nerve Preservation ◽  
Greater Superficial Petrosal Nerve ◽  
Cranial Fossa ◽  
Video Case Report

Objective This video was aimed to demonstrate the middle fossa approach for the resection of an intracanalicular vestibular schwannoma. Design Present study is a video case report. Setting The operative video is showing a microsurgical resection. Participant The patient was a 59-year-old man who presented with worsening headache and right-side hearing loss. He was found to have a right intracanalicular vestibular schwannoma. After weighing risks and benefits, he chose surgery to remove his tumor. Since his hearing remained “serviceable,” a middle fossa approach was chosen. Main Outcome Measures Pre- and postoperative patient photographs evaluated the muscles of facial expression as a marker for facial nerve preservation. Results A right middle fossa craniotomy was performed which allowed access to the floor of the middle cranial fossa. The greater superficial petrosal nerve (GSPN) and arcuate eminence were identified. Using these two landmarks, the internal acoustic canal (IAC) was localized. After drilling the petrous bone, the IAC was unroofed. The facial nerve was identified by stimulation and visual inspection and the tumor was separated from it with microsurgical dissection. In the end, the tumor was fully resected. Both the facial and cochlear nerves were preserved. Postoperatively, the patient experienced no facial palsy and his hearing is at baseline. Conclusion With radiosurgery gaining increasing popularity, patients with intracanalicular vestibular schwannomas are frequently treated with it, or are managed with observation. The middle fossa approach is therefore becoming a “lost art,” but as demonstrated in this video, remains an effective technique for tumor removal and nerve preservation.The link to the video can be found at: https://youtu.be/MD6o3DF6jYg.

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.

Bilateral traumatic facial paralysis associated with unilateral abducens palsy: a case report

2005 ◽  
Vol 119 (2) ◽  
pp. 144-147 ◽  
Author(s):  
Tuncay Ulug ◽  
S Arif Ulubil
Keyword(s):  
Facial Nerve ◽  
Facial Paralysis ◽  
Motor Vehicle ◽  
Bone Fractures ◽  
Middle Cranial Fossa ◽  
Geniculate Ganglion ◽  
Abducens Palsy ◽  
Middle Cranial Fossa Approach ◽  
Cranial Fossa ◽  
The Right

Bilateral traumatic facial paralysis is a very rare clinical condition. Abducens palsy, associated with bilateral traumatic paralysis, is even rarer and has not been well described in the literature. In this report, a 24-year-old male, who developed immediate bilateral facial and right abducens paralyses following a motor vehicle accident, is presented. The patient was referred for neurotologic evaluation 22 days after the injury. Electroneurography (ENoG) demonstrated 100 per cent degeneration at the first examination and, correspondingly, electromyography showed no regeneration potentials. Using high-resolution computed tomography (HRCT), a longitudinal fracture on the right and a mixed-type fracture on the left were identified. The patient had good cochlear reserve on both sides. The decision for surgery was based not on ENoG, because of the delayed referral of the patient, but on the HRCT, which showed clear fracture lines on both sides. The middle cranial fossa approach for decompression of the right facial nerve was performed on the 55th day following the trauma, and a combined procedure using the middle cranial fossa and transmastoid approaches was applied for decompression of the left facial nerve on the 75th day following the trauma. On the right, there was dense fibrosis surrounding the geniculate ganglion and the proximal tympanic segment whereas, on the left, bone fragments impinging on the geniculate ganglion, dense fibrosis surrounding the geniculate ganglion, and a less extensive fibrotic tissue surrounding the pyramidal segment were encountered. There were no complications or hearing deterioration. At the one-year follow up, the patient had House-Brackmann (HB) grade 1 recovery on the right, and HB grade 2 recovery on the left side, and the abducens palsy regressed spontaneously. The middle cranial fossa approach and its combinations can be performed safely in bilateral temporal bone fractures as labyrinthine sparing procedures if done on separate occasions.

scholarly journals Cerebellopontine angle facial schwannoma relapsing towards middle cranial fossa

2011 ◽  
Vol 1 (2) ◽  
pp. 32 ◽  
Author(s):  
Takafumi Nishizaki ◽  
Norio Ikeda ◽  
Shigeki Nakano ◽  
Takanori Sakakura ◽  
Masaru Abiko ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Cerebellopontine Angle ◽  
Middle Cranial Fossa ◽  
Petrous Bone ◽  
Middle Fossa ◽  
Facial Spasm ◽  
History Of ◽  
Staged Operation ◽  
Cranial Fossa ◽  
Magnetic Resonance Imaging Mri

Facial nerve schwannomas involving posterior and middle fossas are quite rare. Here, we report an unusual case of cerebellopontine angle facial schwannoma that involved the middle cranial fossa, two years after the first operation. A 53-year-old woman presented with a 3-year history of a progressive left side hearing loss and 6-month history of a left facial spasm and palsy. Magnetic resonance imaging (MRI) revealed 4.5 cm diameter of left cerebellopontine angle and small middle fossa tumor. The tumor was subtotally removed via a suboccipital retrosigmoid approach. The tumor relapsed towards middle cranial fossa within a two-year period. By subtemporal approach with zygomatic arch osteotomy, the tumor was subtotally removed except that in the petrous bone involving the facial nerve. In both surgical procedures, intraoperative monitoring identified the facial nerve, resulting in preserved facial function. The tumor in the present case arose from broad segment of facial nerve encompassing cerebellopontine angle, meatus, geniculate/labyrinthine and possibly great petrosal nerve, in view of variable symptoms. Preservation of anatomic continuity of the facial nerve should be attempted, and the staged operation via retrosigmoid and middle fossa approaches using intraoperative facial monitoring, may result in preservation of the facial nerve.

Microsurgical Anatomy of the Perigeniculate Ganglion Area as Seen from the Middle Cranial Fossa Approach

2003 ◽  
Vol 112 (6) ◽  
pp. 531-533 ◽  
Author(s):  
Ho-Ki Lee ◽  
Won-Sang Lee
Keyword(s):  
Facial Nerve ◽  
Middle Cranial Fossa ◽  
Point Of View ◽  
Detailed Knowledge ◽  
Geniculate Ganglion ◽  
Microsurgical Anatomy ◽  
Middle Fossa Approach ◽  
Middle Cranial Fossa Approach ◽  
Cranial Fossa ◽  
Temporal Bones

The middle cranial fossa approach is useful for decompressing the perigeniculate ganglion area of the facial nerve in patients with serviceable hearing. The present study was designed to investigate the microsurgical anatomy of the perigeniculate ganglion area of the facial nerve from the point of view of the middle cranial fossa. We dissected 20 human temporal bones under a microscope using a middle fossa approach, and measured the angle between the lines drawn from the malleus head to the vertical crest and from the malleus head to the geniculate ganglion, and the distance from the malleus head to the geniculate ganglion. These were found to be 22.7° ± 2.2° and 6.5 ± 0.3 mm, respectively. Detailed knowledge about the microsurgical anatomy of the perigeniculate ganglion area of the facial nerve from the point of view of the middle cranial fossa is imperative for facial nerve decompression by a middle cranial fossa approach.

Outer Table Graft in Middle Fossa Surgery

1994 ◽  
Vol 111 (1) ◽  
pp. 70-75 ◽  
Author(s):  
Christopher J. Linstrom ◽  
Marek J. Krajewski ◽  
Aaron L. Shapiro ◽  
Salvatore Caruana
Keyword(s):  
Surgical Technique ◽  
Facial Nerve ◽  
Middle Cranial Fossa ◽  
Middle Fossa ◽  
Nerve Decompression ◽  
Cranial Fossa ◽  
Middle Cranial Fossa Surgery ◽  
Facial Nerve Decompression ◽  
Outer Table

We describe a surgical technique in which the middle fossa craniotomy ordinarily used for facial nerve decompression and related surgery is extended superiorly to allow the harvest of a split-thickness calvarial graft. This graft allows the tegmen defect in middle fossa surgery to be repaired without shortening the original craniotomy plate. Avoiding the usual temporoparietal depression after middle cranial fossa surgery is both a structural and cosmetic benefit for the patient.

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