Anatomy and Significance of the Temporal Fat Pad in Apert Syndrome

1994 ◽  
Vol 31 (3) ◽  
pp. 224-227 ◽  
Author(s):  
Rick J. Smith ◽  
Ian T. Jackson
Keyword(s):  
Lateral Displacement ◽  
Three Dimensional ◽  
Middle Cranial Fossa ◽  
Apert Syndrome ◽  
Temporal Region ◽  
Fat Pad ◽  
Temporalis Muscle ◽  
Temporal Fossa ◽  
Cranial Fossa ◽  
Normal Controls

Abnormal temporal region anatomy In Apert syndrome described in the literature includes inferior and lateral displacement of the middle cranial fossa, effacement of the temporal fossa, and thinning of the temporalis muscle. Four patients with Apert syndrome were noted to have hyperplasia of the bilateral superficial temporal fat pads, which could be contoured surgically. A case is presented with reformatted three-dimensional computed tomography (3-D CT) scans with intraoperative documentation of Increased temporal fat as compared to normal controls.

scholarly journals Euclidean Relationship between the Superior Semicircular Canal and the Arcuate Eminence

2019 ◽  
Vol 81 (02) ◽  
pp. 165-171 ◽  
Author(s):  
Aida Nourbakhsh ◽  
Yang Tang ◽  
Brian S. DiPace ◽  
Daniel H. Coelho
Keyword(s):  
Semicircular Canal ◽  
Euclidean Distance ◽  
Three Dimensional ◽  
Middle Cranial Fossa ◽  
Surgical Anatomy ◽  
P Value ◽  
Middle Fossa ◽  
Superior Semicircular Canal ◽  
Cranial Fossa ◽  
Academic Teaching Hospital

Abstract Objective This study was aimed to better characterize the surgical anatomy of the floor of the middle cranial fossa using three dimensional Euclidean relationships between the arcuate eminence (AE), the superior semicircular canal (SSC), and the geniculate ganglion (GG). Study Design Submillimeter distances were recorded from computed tomography (CT) scans of 50 patients (100 sides). The AE, apex of the SSC, and the GG were identified and three dimensional distances measured. Setting The study was conducted at a tertiary academic teaching hospital. Main Outcome Measures In this study, Euclidean distance was obtained from AE to SSC by using a fixed anatomical landmark (GG) as the origin. Results On average, the AE is 2.1 ± 0.3 mm lateral, 2.5 ± 0.1 mm superior, and 2.1 ± 0.3 posterior to the SSC. Thirty percent (30/100) of patients had an AE that was less than 2 mm superior to SSC. The AE was medial to the SCC in 13% samples and anterior to the SSC in 18% samples. The results also show that there was no difference in mean distance between sides (1.08 mm; 95% confidence interval [CI] =  − 2.67–0.52; p-value = 0.29) or gender (0.56 mm; 95% CI =  − 1.34, 2.45; p-value = 0.86). Conclusions This study represents a comprehensive analysis of the relational anatomy of the floor of the middle fossa to date. In quantifying relationships between the AE, SSC, and GG, and by understanding the variability of these relationships in some planes, the middle fossa surgeon can feel more comfortable with this most challenging approach.

The Relationship Between the Zygomatic Arch and the Floor of the Middle Cranial Fossa

2010 ◽  
Vol 66 (suppl_2) ◽  
pp. ons363-ons369 ◽  
Author(s):  
Hayan Dayoub ◽  
William B. Schueler ◽  
Hakeem Shakir ◽  
Kristopher T. Kimmell ◽  
Eric H. Sincoff
Keyword(s):  
Computed Tomography ◽  
Muscle Thickness ◽  
Middle Cranial Fossa ◽  
Cranial Base ◽  
Zygomatic Arch ◽  
P Value ◽  
Temporalis Muscle ◽  
Computed Tomography Scans ◽  
Cranial Fossa ◽  
Vertical Height

Abstract OBJECTIVE Access to the floor of the middle cranial fossa (MCF) is often required for approaches to cranial base lesions. This study measures the craniocaudal distance between the zygomatic arch (ZA) and the floor of the MCF from a random sample of high-resolution computed tomography scans of the cranial base. Methods Forty computed tomography scans were imported into an OsiriX station and reconstructed in multiple planes. The most caudal point of the MCF was determined in each computed tomography scan. The distances between that point and the root of the zygoma and the middle point of the ZA were calculated. The thickness of the temporalis muscle and the vertical height of the zygoma were also calculated. A 2-tailed, paired Student t test was used to compare right and left measurements with a 95% confidence interval and P value <.05 as statistically significant. RESULTS The foramen ovale was consistently the lowest point of the MCF. The average root-to-floor measurement was 5.05 ± 0.42 mm above the floor of the MCF and distance of the mid-zygoma to the floor was 1.94 ± 0.61 mm above the floor of MCF. The average temporalis muscle thickness and vertical height of the ZA were 22.22 ± 0.36 mm and 8.10 ± 0.13 mm, respectively. The muscle-to-floor measurement (muscle thickness + mid-zygoma-to-floor measurement) was 24.16 ± 0.74 mm. Conclusion The routine use of a zygomatic osteotomy in approaches to the MCF does not provide very much increased exposure. However, in patients with exceptionally thick temporalis muscles or a high ZA, a zygomatic osteotomy may be helpful in providing exposure of the floor of the MCF.

scholarly journals Three-dimensional assessment of the middle cranial fossa and central skull base following Herbst appliance treatment

2018 ◽  
Vol 88 (6) ◽  
pp. 757-764
Author(s):  
Karine Sayure Okano ◽  
Lucia Helena Soares Cevidanes ◽  
Paula Loureiro Cheib ◽  
Antonio Carlos de Oliveira Ruellas ◽  
Marília Yatabe ◽  
...  
Keyword(s):  
Skull Base ◽  
Visual Analysis ◽  
Three Dimensional ◽  
Middle Cranial Fossa ◽  
Spatial Behavior ◽  
Anterior Cranial Fossa ◽  
Control Group ◽  
Anatomical Landmarks ◽  
Herbst Appliance ◽  
Cranial Fossa

ABSTRACT Objectives: The purpose of this three-dimensional (3D) study was to assess retrospectively the middle cranial fossa and central skull base of patients treated with the Herbst appliance (HA). Materials and Methods: 3D surface virtual models of 40 Class II, division 1 malocclusion patients were generated from cone-beam computed tomography (CBCT) acquired before treatment (T0) and after 8 months of HA treatment (T1). T0 and T1 3D models were superimposed volumetrically at the anterior cranial fossa. Twenty subjects who had been treated with the Herbst appliance (HAG) were compared to 20 subjects who were not treated orthopedically. The latter group served as a comparison control group (CG). Quantitative assessments of the location and directional changes were made with linear and angular measurements between anatomical landmarks. Qualitative assessments of the spatial behavior of the middle cranial fossa and central skull base relative to the anterior cranial fossa were displayed graphically for visualization with color maps and semitransparent overlays. Non-parametric tests were performed to compare the between the HAG and CG. Results: Point-to-point linear measurements and skeletal rotation (pitch, roll, and yaw) changes were very small along the observational period and were not significantly different between HAG and CG. Visual analysis of color maps and overlays confirmed that no changes in the cranial base were associated with HA. Conclusions: HA therapy did not produce clinically significant changes in the middle cranial fossa and central skull base.

scholarly journals Aneurysmal bone cyst: а case report

2019 ◽  
Vol 20 (4) ◽  
pp. 52-60
Author(s):  
Sh. A. Aul ◽  
A. G. Bobylev ◽  
T. M. Shogunbenkov ◽  
А. M. Gazeev ◽  
E. A. Osipova ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Temporal Bone ◽  
Aneurysmal Bone Cyst ◽  
Bone Cyst ◽  
Middle Cranial Fossa ◽  
Temporal Region ◽  
Left Temporal Lobe ◽  
Nerve Paresis ◽  
Cranial Fossa ◽  
The Brain

The study objective is to describe a clinical case of intracranial aneurysmal bone cyst in a 9-year-old patient with peripheral facial nerve paresis on the left.Materials and methods. In a 9-year-old patient with facial asymmetry and pain syndrome on the results of magnetic resonance imaging of the brain with contrast in the upper edge of the left temporal bone pyramid revealed inhomogeneous encapsulated lesion with the level of media separation in the structure, high-intensity zones on T1and T2-weighted images, additional intracranial lesion in the left temporal region. Multispiral computer tomography of the brain revealed a cystic-solid lesion with clear contours, causing destruction of the pyramid of the left temporal bone. Lesion spreads to the middle cranial fossa with compression of the basal parts of the left temporal lobe. The diagnosis was made: neoplasm of the left temporal bone (possibly primary cholesteatoma) with destruction of the pyramid and petrosal part of the temporal bone and clivus with suppuration and formation of abscess of the left temporal lobe. Left facial nerve paresis. Osteo-plastic trepanation of the skull in the left temporal region, microsurgical removal of the tumor of the base of the middle cranial fossa on the left and plastic of the skull base defect with abdominal fat were performed.Results. The postoperative period was uneventful. The patient complained of moderate headaches in the area of operative access. The wound healed by primary tension. Positive dynamics in neurological status in the form of regression of left facial nerve paresis was noted. Based on the data of morphological and immunohistochemical studies, an aneurysmal bone cyst was diagnosed.Conclusion. The method of choice in the treatment of an aneurysmal bone cyst of the skull base is the en block removal. In case of impossibility of carrying out radical operation radiotherapy and embolization of the vessels feeding a cyst can be used, however convincing researches about their efficiency in such cases are not published. Aneurysmal bone cyst is uncommon, and to differentiate it from chondroblastoma, teleangiectatic osteosarcoma and giant cell tumors is rather difficult, therefore, it is necessary to increase the level of knowledge about this nosology.

A combined frontotemporal and lateral infratemporal fossa approach to the skull base

1988 ◽  
Vol 68 (5) ◽  
pp. 678-683 ◽  
Author(s):  
Bruce Mickey ◽  
Lanny Close ◽  
Steven Schaefer ◽  
Duke Samson
Keyword(s):  
Cavernous Sinus ◽  
Infratemporal Fossa ◽  
Middle Cranial Fossa ◽  
Low Grade ◽  
Orbital Apex ◽  
Upper Aerodigestive Tract ◽  
Temporalis Muscle ◽  
Anterior Portion ◽  
Content Type ◽  
Cranial Fossa

✓ A variety of neoplasms involve both the infratemporal fossa and the base of the middle cranial fossa, in medial proximity to the cavernous sinus and orbital apex. To provide simultaneous access to both the intracranial and extracranial aspects of these tumors, a temporal or frontotemporal craniotomy may be combined with a lateral exposure of the infratemporal fossa. The approach, which is readily achieved by a neurosurgeon and an otolaryngologist acting as a team, involves a unilateral frontotemporal incision extended inferiorly onto the neck, a lateral facial flap reflected anteriorly, and transection of the zygoma followed by its reflection inferolaterally with the temporalis muscle. This exposure provides excellent visualization of both the intradural and extradural aspects of the anterior portion of the cavernous sinus, allowing for an aggressive resection of neoplasms involving this region. Experience with this procedure is reported here in the management of nine patients: three with nasopharyngeal angiofibromas, three with low-grade malignancies of the upper aerodigestive tract, and three with sphenoid ridge meningiomas.

Greater superficial petrosal nerve neurinoma

1999 ◽  
Vol 91 (4) ◽  
pp. 691-696 ◽  
Author(s):  
Yoshiaki Kumon ◽  
Saburo Sakaki ◽  
Shinsuke Ohta ◽  
Shiro Ohue ◽  
Koh Nakagawa ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Surgical Excision ◽  
Middle Cranial Fossa ◽  
Magnetic Resonance Images ◽  
Tympanic Cavity ◽  
Content Type ◽  
Complete Surgical Excision ◽  
Greater Superficial Petrosal Nerve ◽  
Cranial Fossa ◽  
Conductive Hearing

✓ The authors report a case of middle cranial fossa neurinoma arising from the left greater superficial petrosal nerve in a 21-year-old woman who presented with a left-sided otitis media that chronically recurred over a period of 5 years. On examination, the patient had a left-sided mild conductive hearing impairment and a slight disturbance in tear secretion on the left side, with sensory disturbance in the left palate. Three-dimensional computerized tomography scans clearly demonstrated the enlargement of the foramen lacerum and foramen ovale, and heavily T2-weighted magnetic resonance images revealed the tumor's location along with the course of the greater superficial petrosal nerve and its extension into the tympanic cavity. Following complete surgical excision of the tumor and tympanoplasty via a middle cranial fossa approach, the patient retained useful hearing without facial palsy.

Three-dimensional Computed Tomographic Analysis of the Relationship Between the Arcuate Eminence and the Superior Semicircular Canal

2006 ◽  
Vol 59 (suppl_1) ◽  
pp. ONS-7-ONS-12 ◽  
Author(s):  
Ketan R. Bulsara ◽  
Jean-Christophe Leveque ◽  
Linda Gray ◽  
Takanori Fukushima ◽  
Allan H. Friedman ◽  
...  
Keyword(s):  
Semicircular Canal ◽  
Average Distance ◽  
Three Dimensional ◽  
Middle Cranial Fossa ◽  
Surgical Approaches ◽  
Precise Position ◽  
Superior Semicircular Canal ◽  
Bony Landmarks ◽  
Cranial Fossa ◽  
The Relationship

Abstract OBJECTIVE: The location of the superior semicircular canal (SSC) is often determined intraoperatively based on its topographic association with the arcuate eminence (AE). This determination is not always possible because of the potential variability in the relationship between these two structures. The goal of this study was to describe the three-dimensional (3-D) relationship between the AE and SSC using 3-D computed tomography (CT) and to evaluate the utility of 3-D CT for preoperative planning for surgical approaches to the middle cranial fossa. METHODS: We studied 11 patients (22 sides) radiographically using 0.8- to 1-mm thick reconstructed CT images. A standard set of structural relationships was measured between the AE, SSC, and other regional landmarks. RESULTS: 3-D CT clearly demonstrated the relationships between traditional landmarks along the petrous ridge and middle cranial fossa. The relationship between the arcuate eminence and SSC was found to be highly variable. The average distance between the tips of the two structures was found to be 5.7 mm (range, 2.7–10.4 mm). CONCLUSIONS: There is significant variability in the relationship between the AE and the SSC. The AE is not a consistent or reliable landmark for identifying the precise position of the SSC. Detailed preoperative information regarding the relationship between the AE, SSC, and other bony landmarks can be easily and quickly assessed using 3-D CT.

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