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Méndez Rosito D, Borrayo-Dorado S, Zorrilla-Madera E, Sánchez-Gallardo JF, Gallardo-Ceja D, Ríos FJ, Cárdenas Y, Palmisciano P, Forbes JA, Abdala-Vargas NJ. The M-Point A Novel Landmark in Middle Fossa Surgery: A Cadaveric Morphometric Study. World Neurosurg 2024; 181:e67-e74. [PMID: 37385439 DOI: 10.1016/j.wneu.2023.06.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND The arcuate eminence (AE) is an anatomically consistent bony protrusion located on the upper surface of the petrous bone that has been previously studied as a reference for lateral skull base approaches. There is a paucity of information in the neurosurgical literature seeking to improve the safety of the extended middle cranial fossa (MCF) approach using detailed morphometric analysis of the AE. OBJECTIVE To evaluate the use of the AE as an anatomical landmark to help with early identification of the internal acoustic canal (IAC) in MCF approaches by means of a cadaveric study, using a new morphometric reference termed the "M-point." METHODS A total of 40 dry temporal bones and 2 formalin-preserved, latex-injected cadaveric heads were used. The M-point was established as a new anatomic reference by identifying the intersection of a line perpendicular to the alignment of the petrous ridge (PR), originating from the midpoint of the AE, with the PR itself. Subsequent anatomical measurements were performed to measure the distance between M-point and IAC. Additional distances, including PR length and the anteroposterior and lateral AE surfaces, were also measured. RESULTS The mean distance between the M-point and the center of the IAC was 14.9 mm (SD ± 2.09), offering a safe drilling area during an MCF approach. CONCLUSIONS This study provides novel information on identification of a new anatomic reference point known as the M-point that that can be used to improve early surgical identification of the IAC.
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Affiliation(s)
- Diego Méndez Rosito
- Laboratorio de Base de Cráneo, Centro Médico Nacional 20 de Noviembre, ISSSTE, Mexico City, Mexico.
| | - Sheila Borrayo-Dorado
- Laboratorio de Base de Cráneo, Centro Médico Nacional 20 de Noviembre, ISSSTE, Mexico City, Mexico
| | - Elias Zorrilla-Madera
- Laboratorio de Base de Cráneo, Centro Médico Nacional 20 de Noviembre, ISSSTE, Mexico City, Mexico
| | | | - David Gallardo-Ceja
- Laboratorio de Base de Cráneo, Centro Médico Nacional 20 de Noviembre, ISSSTE, Mexico City, Mexico
| | - Francisco J Ríos
- Department of Anatomy, Escuela Superior de Medicina, IPN, Mexico City, Mexico
| | - Yolanda Cárdenas
- Department of Anatomy, Escuela Superior de Medicina, IPN, Mexico City, Mexico
| | - Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jonathan A Forbes
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Nadin J Abdala-Vargas
- Laboratorio de Base de Cráneo, Centro Médico Nacional 20 de Noviembre, ISSSTE, Mexico City, Mexico; Department of Neurological Surgery, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital de San José, Bogotá, Colombia
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Yang H, Li M, Chen G, Liang J, Bao Y, Li M, Ling F. Using the Arcuate Eminence-Trigeminal Notch Line to Localize the Anterior Wall of the Internal Auditory Canal in a Subtemporal Approach: An Anatomical Study. J Neurol Surg B Skull Base 2020; 82:e196-e202. [PMID: 34306937 DOI: 10.1055/s-0040-1701601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 12/24/2019] [Indexed: 10/24/2022] Open
Abstract
Background This article aims to describe the regional anatomy of the anterior end of the arcuate eminence, the lateral end of the trigeminal notch, and the line connecting the two (i.e., the arcuate eminence-trigeminal notch line [ATL]) and to determine whether the ATL could be used as a landmark for localizing the internal auditory canal (IAC). Methods Twenty sides of the middle cranial fossae were examined. The anterior end of the arcuate eminence, the lateral end of the trigeminal notch, the ATL, and other crucial structures were exposed. The relevant distance and angle of related structures in the anterior wall of the petrosal bone were measured. Results The anterior end of the arcuate eminence and the lateral end of the trigeminal notch could be identified in all specimens. The anterior end of the arcuate eminence lay over the geniculate ganglia and the vestibule area, and could be visualized directly or determined from the intersection of the long axes of the greater superficial petrosal nerve and arcuate eminence. On the petrous ridge, the lateral end of the trigeminal notch was also the transitional point of the suprameatal tubercle and trigeminal notch. The ATL corresponded to the projection of the anterior wall of the IAC on the anterior surface of the petrous bone. Conclusion The ATL corresponded to the projection of the anterior wall of the IAC on the anterior petrous surface and could be used as an alternative landmark for localizing the anterior wall of the IAC.
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Affiliation(s)
- Haifeng Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,Samii's Clinical Neuroanatomy Research and Training Center, China International Neuroscience Institute (China-INI), Beijing, China
| | - Mengjun Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,Samii's Clinical Neuroanatomy Research and Training Center, China International Neuroscience Institute (China-INI), Beijing, China
| | - Ge Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,Samii's Clinical Neuroanatomy Research and Training Center, China International Neuroscience Institute (China-INI), Beijing, China
| | - Jiantao Liang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,Samii's Clinical Neuroanatomy Research and Training Center, China International Neuroscience Institute (China-INI), Beijing, China
| | - Yuhai Bao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,Samii's Clinical Neuroanatomy Research and Training Center, China International Neuroscience Institute (China-INI), Beijing, China
| | - Mingchu Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,Samii's Clinical Neuroanatomy Research and Training Center, China International Neuroscience Institute (China-INI), Beijing, China
| | - Feng Ling
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,Samii's Clinical Neuroanatomy Research and Training Center, China International Neuroscience Institute (China-INI), Beijing, China
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da Franca Pereira MA, Bittencourt AG, de Andrade EM, Bento RF, de Brito R. Decompression of the tympanic and labyrinthine segments of the facial nerve by middle cranial fossa approach: an anatomic study. Acta Neurochir (Wien) 2016; 158:1205-11. [PMID: 27068046 DOI: 10.1007/s00701-016-2796-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 03/27/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Peripheral facial palsy is characterized by the permanent or temporary interruption of facial muscle function. The middle cranial fossa (MCF) approach has been used to decompress the facial nerve (FN) when hearing needs to be preserved. In this work, we describe a technique for decompressing the FN through the MCF approach, which allows the direct exposure of the labyrinthine and entire tympanic segment of the FN, with preservation of inner ear function. METHODS Twenty cadavers heads were used in this study. The reference landmarks used were the middle meningeal artery, greater superficial petrosal nerve, arcuate eminence, inferior petrosal sinus and meatal plane following the petrous apex from its most anterior and medial portion. RESULTS The tympanic segment of the FN presented, on average, a total length of 11 ± 0.67 mm to the right and 11.5 ± 0.60 mm to the left. The longitudinal lengths of the bone window in the tegmen tympani were 16.8 ± 1.67 mm to the right and 16.8 ± 1.20 mm to the left. The cross-sectional lengths of the bone window in the tegmen tympani were 5.5 ± 1.20 mm and 5.0 ± 1.75 mm to the right and left sides, respectively. The average value of the elliptical area formed by the longitudinal and transversal lengths of the bone window made in the tegmen tympani was 72.5 ± 22.5 mm(2) to the right and 65.9 ± 30.3 mm(2) to the left. CONCLUSION The proposed technique can be used for the surgical decompression of the tympanic, labyrinthine and meatal segments of the FN through the MCF in addition to reducing the surgical time and the risk to patients.
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Affiliation(s)
- Marcos Alexandre da Franca Pereira
- Department of Otolaryngology, Nova Esperança Medical School (FAMENE), Rua Gov. Antonio da Silva Mariz, 600\198, João Pessoa, Brazil, CEP 58046-518.
- Department of Otolaryngology, University of São Paulo School of Medicine, São Paulo, Brazil.
| | | | - Emerson Magno de Andrade
- Division of Functional Neurosurgery, Department of Neurology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Ricardo Ferreira Bento
- Department of Otolaryngology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Rubens de Brito
- Department of Otolaryngology, University of São Paulo School of Medicine, São Paulo, Brazil
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