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Skull Base 2007; 17(6): 395-403
DOI: 10.1055/s-2007-991117
ORIGINAL ARTICLE

© Thieme Medical Publishers

The Middle Cranial Fossa: Morphometric Study and Surgical Considerations

Raffaella Maina1 , 2 , Alessandro Ducati2 , Giuseppe Lanzino1
  • 1Department of Neurosurgery, Microneurosurgical Laboratory, Illinois Neurological Institute, University of Illinois College of Medicine at Peoria, Peoria, Illinois
  • 2Molinette Hospital, University of Torino, Italy
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Publication History

Publication Date:
18 October 2007 (online)

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Commentary “The Middle Cranial Fossa: Morphometric Study and Surgical Considerations”Skull Base 2007; 17(06): 403-403
DOI: 10.1055/s-2007-991118

ABSTRACT

The anatomical features of the temporal bone can vary significantly among different individuals. These variations affect the operative view in middle cranial fossa surgery. We performed 18 middle fossa approaches in 9 cadaveric heads, with detailed morphological analysis, to identify unfavorable situations and reliable systems to avoid complications during surgery. We recorded linear, angular measurements and calculated areas. We performed a computed tomography (CT) scan with analysis of the amount of bone to remove in two temporal bones. We found that the location of the internal auditory canal (IAC) is the keystone of bone removal. We also found accuracy in the system suggested by E. and J. L. Garcia-Ibanez for its identification and that there is a smaller surgical window in female patients (statistically significant) that can be predicted on preoperative imaging studies. Our study also confirms significant individual variability in the mutual relationships of different surgical landmarks. We concluded that surgery of the middle fossa requires detailed understanding of the complex temporal bone anatomy. The surgeon has to be aware of extreme variability of the more commonly used anatomical landmarks. The method to identify the position of the IAC described by E. and J. L. Garcia-Ibanez seems to be the simplest and most reliable. When the surgical strategy includes an anterior petrosectomy, interindividual variability can critically affect the working area, particularly in females. The working area can be estimated on preoperative CT scans through the petrous bone.

KEYWORDS

Middle fossa approach - temporal bone - landmarks - measurements - microsurgical anatomy - transpetrous approach

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Giuseppe LanzinoM.D. 

Department of Neurosurgery, Illinois Neurological Institute

530 NE Glen Oak Avenue, Peoria, IL 61637

Email: Lanzino@uic.edu