Surgical Exposure of the Petrous Internal Carotid Artery: Practical Application for Skull Base Surgery

Dew, Leigh Anne; Shelton, Clough; Harnsberger, H R; Thompson, B. Gregory

doi:10.1097/00005537-199707000-00026

Cited by 33 publications

(23 citation statements)

References 16 publications

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“…By estimating the distance using a Sheehy knife curette (diameter 2.8 mm), the dense bone surrounding the cochlea can be safely removed. 3 In this study, it was also reported that 64% of surgical specimens showed crossing of the GSPN along with the petrous ICA from the medial to lateral side. We assumed that if this crossing phenomenon is observed after identification of the petrous ICA, the cochlear line may be the first reliable evidence that allows approximation of the location of the cochlea.…”

Section: Resultssupporting

confidence: 55%

Cochlear line: a novel landmark for hearing preservation using the anterior petrosal approach

Kim¹,

Lee

Kim

et al. 2015

JNS

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T he anterior petrosal approach introduced by Kawase et al. was designed to enable wider and closer surgical exposure for treatment of ventral brainstem lesions. 1 The technique provides easy access to large sphenopetroclival meningiomas, dumbbell-shaped trigeminal schwannomas, and giant acoustic neuromas located in front of the brainstem and basilar trunk aneurysms. 5,7,9 The advantage of this technique is a lower possibility of postoperative hearing loss, vestibulopathy, and facial paresis in comparison with the transcochlear approach and/ or combined middle fossa posterior approach, which both provide similar surgical fields. 1To perform the anterior petrosal approach more safely, the use of possible anatomical landmarks, including the maxillary branch of the trigeminal nerve (V3), gasserian ganglion, greater superficial petrosal nerve (GSPN), petrous internal carotid artery (ICA), cochlea, geniculate ganglion, dura mater of the internal acoustic canal (IAC), labyrinthine portion of the facial nerve, vestibule, and superior semicircular canal can also be put to good use. Of these, the cochlea is well known to be located anterior to the fundus of the IAC, inferior to the geniculate ganglion. This relationship is frequently used as an anatomical landmark. In addition, the difference in bone density between the petrous bone and the cochlea can also be another clue for determining the location of the cochlea. 4 However, surgeons may be faced with unexpected difficulty in applying these concepts in real surgical fields. In this study, based on dissection results in 5 fresh cadavers, we aimed to develop a practical landmark for the safe and easy identification of the cochlea when applying the anterior petrosal approach. MethodsThis study was approved by the institutional review board of Eulji University. Five fresh cadaver heads were dissected in the microdissection laboratory.abbreviatioNs GSPN = greater superficial petrosal nerve; IAC = internal acoustic canal; ICA = internal carotid artery; V3 = maxillary branch of the trigeminal nerve. obJect The goal of this study was to develop a practical landmark for the safe and easy identification of the cochlea when performing anterior petrosectomy based on cadaver dissection results. Methods The cochlear line was defined as the line drawn from the crossing point between the greater superficial petrosal nerve (GSPN) and the petrous internal carotid artery to the line drawn over the apex of the superior circumference of the dura of the internal auditory canal at a right angle. The validity of the cochlear line marking the anteromedial perimeter of the cochlea at the angle of the GSPN and the internal acoustic canal as a practical landmark were evaluated using 5 cadaver heads. results The mean distance (± SD) measured from the cochlear line to the margin of the cochlear cavity was 2.25 ± 0.51 mm (range 1.50-3.00 mm). coNclusioNs Anterior petrosectomy can be performed more efficiently by using the cochlear line as a key landmark to preserve the cochlea.

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Section: Resultssupporting

confidence: 55%

Cochlear line: a novel landmark for hearing preservation using the anterior petrosal approach

Kim¹,

Lee

Kim

et al. 2015

JNS

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“…The second, the petrous segment of the carotid artery itself, has two segments: a vertical segment, which turns in an anterior and medial direction towards the petrous apex to become the horizontal segment, housed within a bony carotid canal, ending at the posterior aspect of the foramen lacerum. The cochlea is closest to the carotid artery at the genu between the vertical and horizontal segments, and this distance has been reported to range between 0.2 and 10 mm [4,5,6,7,8]. In a microscopic study of 122 human temporal bones, Penido et al [1] found that the mean distance between the carotid artery and the basal turn of the cochlea was 2.04 mm.…”

Section: Discussionmentioning

confidence: 99%

Contemporary Neuroradiographic Assessment of the Cochleo-Carotid Partition

Samy¹,

Pensak²

2016

ORL

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Purpose: The cochleo-carotid partition (CCP) describes the intimate anatomic relationship between the petrous carotid artery and the cochlear basal turn. This partition bears significant surgical and unique clinical relevance. The purpose of this paper is to radiographically assess the CCP and discuss its clinical implications. Methods: A total of 155 consecutive fine-cut temporal bone CT scans were retrospectively reviewed, and study scans were digitally analyzed in both axial and coronal views. The shortest distance between the petrous carotid canal and the cochlear basal turn was measured. Results: In all, 310 temporal bones were studied, with a mean CCP of 1.9 mm (range 0.2-8.5, SD 1.1). The following CCP measurements were obtained: ≤1.0 mm [n = 46 (14.8%)]; 1.1-2.0 mm [n = 161 (51.9%)]; 2.1-3.0 mm [n = 29 (9.4%)], and ≥4.0 mm [n = 12 (4.2%)]. One temporal bone (0.3%) had complete CCP dehiscence. There was a positive correlation between each patient's right and left CCP measures (p < 0.005) and a significant negative correlation between CCP grade and age (p = 0.027). Conclusions: The CCP is a narrow anatomic confinement measuring ≤2 mm in 66.7% of patients. Potential implications of the CCP include iatrogenic risks, its possible function as a third inner ear window in patients with audiovestibular symptoms, and pathophysiology of new-onset tinnitus following cochlear implantation.

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“…In such cases, the basal turn of the cochlea is most vulnerable to injury in the exposure of the carotid artery. The cochlea-carotid distance is useful in directing the amount of bone that could be safely removed from the posteromedial aspect of the carotid artery (21).…”

Section: Discussionmentioning

confidence: 99%

Impingement of the Carotid Canal on the Basal Turn of the Cochlea as Pertaining to Cochlear Implantation

Singla

Gupta²,

Gupta³

et al. 2014

Otology &Amp; Neurotology

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Surgical Exposure of the Petrous Internal Carotid Artery: Practical Application for Skull Base Surgery

Cited by 33 publications

References 16 publications

Cochlear line: a novel landmark for hearing preservation using the anterior petrosal approach

Cochlear line: a novel landmark for hearing preservation using the anterior petrosal approach

Contemporary Neuroradiographic Assessment of the Cochleo-Carotid Partition

Impingement of the Carotid Canal on the Basal Turn of the Cochlea as Pertaining to Cochlear Implantation

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