The internal auditory canal (IAC) is 10 to 17 mm in length, and the facial nerve and vestibulocochlear nerve, which consist of the cochlear nerve, the superior vestibular nerve, and the inferior vestibular nerve, run together in the IAC packaged in dura mater. Oort first described the vestibulocochlear anastomoses in 1918, which is important for the understanding of the pathogenesis and pathophysiology of otologic disorders. The current study documents the existence of vestibulofacial and vestibulocochlear neural connections and topographical relationship of the nerves as part of a radiologic evaluation of 73 human temporal bones from brainstem to the lateral portion of IAC.
Objective: The purpose of our study was to investigate the topographical relationship between these nerves along their course from the brainstem through the internal acoustic canal IAC in the living human brain using MR imaging. Materials and Methods:We performed three-dimensional gradient echo balanced Fast Field Echo (3D bFFE) sequence oblique parasagittal MR imaging in 73 healthy subjects. The IACs were analyzed from the brainstem end of the IAC to the fundus in contiguous sections. At five levels, the topographical relationships between the facial and vestibulocochlear nerves (VCN) were recorded. In the lateral portions of the IACs where they separated from each other, the relative sizes of the individual nerves were examined. Results:In general, the facial nerve (FN), which is a round structure, is located anteriorly and superiorly to the vestibulocochlear nerve throughout its course. The vestibulocochlear nerve is usually rectangular; however, it was found to be round and at times triangular in shape near the brainstem, before it became crescent-shaped at the porus in 89% of the cases. The superior vestibular nerve kept its posterosuperior position in the canal, and the inferior vestibular nerve (IVN) and the cochlear nerve (CN) travelled inferior to it. The superior and inferior vestibular nerves were divided by the falciform crest in 53% of the cases. The inferior vestibular nerve was the smallest nerve in 52% of the cases, and the cochlear nerve was the largest in 36% of the cases. Conclusion:To the best of our knowledge, this study is the largest in vivo MR study, and most of our findings differ from previous cadaver studies. Determination of these topographical relationships may facilitate our understanding of the complicated physiological relationships between the 7 th and 8 th nerve complexes during surgery in this region.Key Words: Cochlear nerve, Facial nerve, Magnetic Resonance, Topography, Vestibular nerve Özet Amaç: Bizim amacımız, yaşayan insanlarda MR görüntülemeyi kullanarak, bu sinirlerin beyin sapından, internal akustik kanala kadar olan kısmında topografik ilişkilerini araştırmaktır. Gereç ve Yöntem:Yetmiş üç sağlıklı bireyde 3D gradient echo balanced fast field echo (3D bFFE) sekans oblik parasagittal MR inceleme yaptık. İAK, beyin sapından İAK'ın bitimindeki fundusa kadar, ardışık kesitlerle analiz edildi. Beş seviyede fasiyal ve vestibülokoklear sinirin topografik ilişkileri kaydedildi. İAK'ın lateral bölümünde (sinirin kendi içinde bölümlere ayrıldığı kısımda) sinirlerin rölatif boyutları değer-lendirildi. Bulgular:Genel olarak fasiyal sinir, yuvarlak bir yapıda, anterior yerleşimli ve tüm seyri boyunca vestibulokoklear sinirin süperiorundadır. Vestibulokoklear sinir ıklıkla dikdörtgen şeklindedir. Fakat bazen beyin sapına yakın kısımda yuvarlak ve nadiren üçgen şeklinde ve vakaların %89'unda porusda kresentrik yapıdadır. Superior vestibuler sinir kanal içinde posterosüperior pozisyonunu korur ve inferior vestibüler sinir ve koklear sinir superior vestibüler sinirin altından g...
Intraoperative ultrasound has been using to achieve a proper resection strategy in patients undergoing a hepatic colorectal metastasectomy. This study aims to describe and reveal the place of stereotactic metastasectomy in nonpalpable colorectal liver metastases (CLM). A chart review was initiated for all patients underwent resection for CLM between 2006 and 2011. The data concerning perioperative data and intraoperative strategy were abstracted. Among the 58 patients, who underwent a resection for CLM, 4 (6.9 %) (all men, median age 65.5, range 49-72, years) necessitated a stereotactic metastasectomy. Preoperative evaluations showed 1 (n01), 2 (n02), or 3 (n01) lesions, and intraoperative ultrasound (IUS) found an additional lesion in a case. Stereotactic marking was performed for nonpalpable lesions located in segments IVA, II, and VI and at the junction of segments V and VI. The margins were negative for all lesions both resected with conventional and stereotactic techniques. The examinations of the stereotactic resection materials revealed metastatic adenocarcinoma (patients n02), focal nodular hyperplasia (n 01), and abnormal benign liver histology probably induced by chemotherapy (n01). The median (range) operation and hospitalization periods were 217.5 (150-310) minutes and 5.5 (2-9) days. No complications were observed except biliary fistula in a case, which spontaneously disappeared within 2 weeks. A patient died due to systemic disease including hepatic metastases 33 months after the liver surgery. Stereotactic metastasectomy may be feasible for the removal of nonpalpable CLM. Further evaluations are necessitated to understand the accurate place of this novel technique.
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