scholarly journals The surgical anatomy for multiple-electrode extracochlear implant operations

1988 ◽  
Vol 102 (8) ◽  
pp. 685-688
Author(s):  
Burkhard K-H. G. Franz ◽  
Graeme M. Clark
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Temporomandibular Joint ◽  
Internal Carotid ◽  
Anterior Part ◽  
Middle Cranial Fossa ◽  
Surgical Anatomy ◽  
Direct Access ◽  
Cranial Fossa ◽  
Multiple Electrode

AbstractDirect access to the whole length of the cochlear turns via endaural middle ear approach for the placement of extracochlear electrodes is severely restricted. Approximately 10 mm. of the cochlear turns are accessible, being less than a third of their length. The middle cranial fossa, the facial nerve, the internal carotid artery and the temporomandibular joint restrict the access. A further restriction is caused by the position of the cochlea and the direction of its axis. The anterior part of the cochlea lies anterior to the tympanic membrane and medial to the temporomandibular joint, thus limiting an endaural approach to a posterolateral direction. Despite this limitation small sections of the basal, middle and apical turns of the cochlea can be reached.

The So-Called Cavernous Sinus: A Review of the Controversy and Its Implications for Neurosurgeons

Neurosurgery ◽  
1982 ◽  
Vol 11 (5) ◽  
pp. 712-717 ◽  
Author(s):  
John N. Taptas
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Cranial Nerves ◽  
Sella Turcica ◽  
Middle Cranial Fossa ◽  
Cranial Fossa ◽  
Base Of The Skull ◽  
Extradural Space

Abstract The so-called cavernous sinus is a venous pathway, an irregular network of veins that is part of the extradural venous network of the base of the skull, not a trabeculated venous channel. This venous pathway, the internal carotid artery, and the oculomotor cranial nerves cross the medial portion of the middle cranial fossa in an extradural space formed on each side of the sella turcica by the diverging aspects of a dural fold. In this space the venous pathway has only neighborhood relations with the internal carotid artery and the cranial nerves. The space itself must be distinguished from the vascular and nervous elements that it contains. The revision of the anatomy of this region has not only theoretical interest but also important clinical implications.

scholarly journals Morphometry of Glasscock’s Triangle Pertinent to the Exposure of Horizontal Intrapetrosal Segment of the Internal Carotid Artery

2019 ◽  
Vol 08 (03) ◽  
pp. 093-096
Author(s):  
Abu Ubaida Siddiqui ◽  
Richa Gurudiwan ◽  
Abu Talha Siddiqui ◽  
Nikita Chaudhary ◽  
Meryl Rachel John ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Surface Area ◽  
Racial Differences ◽  
Internal Carotid ◽  
Cranial Nerves ◽  
Middle Cranial Fossa ◽  
Surgical Interventions ◽  
Cadaveric Specimen ◽  
Cranial Fossa

Abstract Background and Aim The specific anatomical triangles around the cavernous sinus are frequently explored areas in neurosurgeries and thus require a methodical approach keeping in mind the possibility of variational anatomy and morphometric differences. One of the most inconsistent triangles is the Glasscock’s (posterolateral) triangle (GT) in the middle cranial fossa. Materials and Methods The present study was undertaken on 26 skull bases of the middle cranial fossa from cadavers and 42 dry adult skulls from the departmental collection to analyze parameters of the GT pertinent to the horizontal intrapetrosal segment of the internal carotid artery. The measurements of all sides of the GT were done and the mean surface area was calculated using Heron’s formula. The findings of the study were compared with earlier works where other methods of investigation were employed, such as, dry bones/computed tomography scans, cadaveric studies. Observations The GT in the present study had a mean surface area of 43 mm2. The study presented with variable morphological and morphometric data as compared with earlier studies. The scientific attribute to the differences in parameters is presumably relevant to the racial differences as well as the pathophysiological condition of the subject. Conclusions Surgical interventions to the base of the skull have evolved enormously over the years. Earlier studies have described the triangle on cadaveric specimen. We have attempted to revisit the area in cadaveric as well as dry skull base. Flawless information of the area under surgery augments safer procedures and reduction in the damage to brain tissue as well as the cranial nerves. The putative clinical implications of the present study are useful in helping in high precision surgeries and enhanced patient care. The highly variable GT needs to be understood properly for a desired culmination in ICA exposure in the intrapetrosal segment.

Endoscopic Transnasal Approach to the Cavernous Sinus versus Transcranial Route: Anatomic Study

2005 ◽  
Vol 56 (suppl_4) ◽  
pp. ONS-379-ONS-389 ◽  
Author(s):  
Luigi Maria Cavallo ◽  
Paolo Cappabianca ◽  
Renato Galzio ◽  
Giorgio Iaconetta ◽  
Enrico de Divitiis ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Middle Cranial Fossa ◽  
Anatomic Landmarks ◽  
Transnasal Approach ◽  
Endoscopic Transnasal Approach ◽  
Cranial Fossa ◽  
Triangular Area

Abstract OBJECTIVE: The aim of the present study was to compare the anatomy of the cavernous sinus via an endoscopic transnasal route with the anatomy of the same region explored by the transcranial route. The purpose was to identify and correlate the corresponding anatomic landmarks both through the endoscopic transnasal transsphenoidal and the microscopic transcranial views. METHODS: Five fresh injected heads (10 specimens) were dissected by the endoscopic transnasal and microsurgical transcranial approaches. A comparison of different microsurgical corridors of the cavernous sinus with the corresponding endoscopic transnasal ones was performed. RESULTS: Through the endoscopic transnasal approach, it is possible to explore only some of the parasellar and middle cranial fossa subregions. Because of the complex multilevel architecture of the cavernous sinus, there is not always a correspondence between the surgical corridors bounded through the transcranial route and those exposed through the endoscopic transnasal approach. Nevertheless, some surgical corridors specific to the endoscopic transnasal route are evident: a C-shaped corridor is identifiable medial to the “intracavernous” internal carotid artery, whereas a wider triangular area is delineable lateral to the internal carotid artery; inside the latter, three more surgical corridors (a superior triangular space, a superior quadrangular space, and an inferior quadrangular space) can be described. CONCLUSION: Different surgical corridors can be defined during the endoscopic transnasal approach to the anteroinferior portion of the cavernous sinus, as already established for the transcranial route as well. Knowledge of these could be useful in decreasing morbidity and mortality during surgery in this region, these approaches being reserved to experienced transsphenoidal surgeons only.

scholarly journals Middle Cranial Fossa Transtemporal Approach to the Intrapetrous Internal Carotid Artery

Skull Base ◽  
1991 ◽  
Vol 1 (03) ◽  
pp. 142-146 ◽  
Author(s):  
James C. Andrews ◽  
Neil A. Martin ◽  
Keith Black ◽  
Vincent F. Honrubia ◽  
Donald P. Becker
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Middle Cranial Fossa ◽  
Cranial Fossa

scholarly journals Endoscopic transnasal transmaxillary approach to the upper parapharyngeal space and the skull base

2019 ◽  
Vol 277 (3) ◽  
pp. 801-807
Author(s):  
Quan Liu ◽  
Huan Wang ◽  
Weidong Zhao ◽  
Xiaole Song ◽  
Xicai Sun ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Internal Carotid ◽  
Parapharyngeal Space ◽  
Middle Cranial Fossa ◽  
Anatomical Landmarks ◽  
Endoscopic Endonasal ◽  
Cranial Fossa ◽  
Optimal Approach

Abstract Purpose Treatment of tumors arising in the upper parapharyngeal space (PPS) or the floor of the middle cranial fossa is challenging. This study aims to present anatomical landmarks for a combined endoscopic transnasal and anterior transmaxillary approach to the upper PPS and the floor of the middle cranial fossa and to further evaluate their clinical application. Methods Dissection of the upper PPS using a combined endoscopic endonasal transpterygoid and anterior transmaxillary approach was performed in six cadaveric heads. Surgical landmarks associated with the approach were defined. The defined approach was applied in patients with tumors involving the upper PPS. Results The medial pterygoid muscle, tensor veli palatini muscle and levator veli palatini muscle were key landmarks of the approach into the upper PPS. The lateral pterygoid plate, foramen ovale and mandibular nerve were important anatomical landmarks for exposing the parapharyngeal segment of the internal carotid artery through a combined endoscopic transnasal and anterior transmaxillary approach. The combined approach provided a better view of the upper PPS and middle skull base, allowing for effective bimanual techniques and bleeding control. Application of the anterior transmaxillary approach also provided a better view of the inferior limits of the upper PPS and facilitated control of the internal carotid artery. Conclusions Improving the knowledge of the endoscopic anatomy of the upper PPS allowed us to achieve an optimal approach to tumors arising in the upper PPS. The combined endoscopic transnasal and anterior transmaxillary approach is a minimally invasive alternative approach to the upper PPS.

Transoral Endoscopic Localization of the Parapharyngeal Internal Carotid Artery

2021 ◽  
Author(s):  
Guoliang Zhang ◽  
Xia Zhao ◽  
Guangbin Sun ◽  
Nan Gao ◽  
Pengcheng Yu ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Styloid Process ◽  
Transoral Approach ◽  
Direct Access ◽  
Carotid Canal ◽  
Bony Landmarks ◽  
The Right ◽  
Maxillary Tuberosity

Abstract Objectives To define transoral endoscopic surgical landmarks for the parapharyngeal segment of the internal carotid artery (ppICA) using cadaveric dissection. Materials and Methods Ten fresh cadaveric heads were dissected to demonstrate the parapharyngeal space anatomy and course of the ppICA as seen in a transoral approach. Anatomical measurements of the distance between the ppICA and bony landmarks were recorded and analyzed. Results The stylohyoid ligament, styloglossus, and stylopharyngeus could be considered to be the safe anterior boundary of the ppICA in the transoral approach; among them, the styloid ligament was the most rigid tissue. Dissection between the stylopharyngeus muscle and superior pharyngeal constrictor muscle provides direct access to the ppICA. At the level of the skull base, the distance from the root of the styloid process to the lateral margin of the external aperture of the carotid canal on the left side and on the right side was 8.57 ± 1.97 and 8.80 ± 1.21 mm, respectively. At the level of the maxillary tuberosity, the distance from the ppICA to the maxillary tuberosity on the left side and on the right side was 31.48 ± 2.24 and 31.01 ± 2.88 mm, respectively. Conclusion The endoscopic-assisted transoral approach can facilitate exposure of the ppICA. The root of the styloid process, styloid ligament, and maxillary tuberosity are critical landmarks in the identification of the ppICA in the transoral approach.

Exposure of the Distal Cervical Segment of the Internal Carotid Artery Using the Trans-spinosum Corridor: Cadaveric Study of Surgical Anatomy

2008 ◽  
Vol 62 (suppl_5) ◽  
pp. ONS354-ONS362 ◽  
Author(s):  
Sebastien C. Froelich ◽  
Khaled M. Abdel Aziz ◽  
Nicholas B. Levine ◽  
Myles L. Pensak ◽  
Philip V. Theodosopoulos ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Facial Nerve ◽  
Temporomandibular Joint ◽  
Internal Carotid ◽  
Cranial Base ◽  
Distal Portion ◽  
Carotid Sheath ◽  
Orbitozygomatic Approach ◽  
Cervical Segment

Abstract Background: Exposure of the most distal portion of the cervical segment of the internal carotid artery (ICA) is technically challenging. Previous descriptions of cranial base approaches to expose this segment noted facial nerve manipulation, resection of the glenoid fossa, and significant retraction or resection of the condyle. We propose a new approach using the frontotemporal orbitozygomatic approach to expose the distal portion of the cervical segment of the ICA via the trans-spinosum corridor. Methods: Six formalin-fixed injected heads were used for cadaveric dissection. Two blocs containing the carotid canal and surrounding region were used for histological examination. Results: The ICA lies immediately medial to the vaginal process. The carotid sheath attaches laterally to the vaginal process. With use of the trans-spinosum corridor, the surgeon's line of sight courses in front of the temporomandibular joint, through the foramen spinosum, spine of the sphenoid, and vaginal process. Removal of the vaginal process exposes the vertical portion of the petrous segment of the ICA. The loose connective tissue space between the adventitia and the carotid sheath is easily entered from above. Incision of the carotid sheath exposes the ICA without disruption of the temporomandibular joint. Conclusion: Control of the cervical segment of the ICA can be critical when dealing with cranial base tumors that invade or surround the petrous segment of the ICA. This novel technique through the trans-spinosum corridor can effectively expose the distal portion of the cervical segment of the ICA without causing manipulation of the facial nerve and while maintaining the integrity of the temporomandibular joint.

Surgical Anatomy of the Internal Carotid Artery

2013 ◽  
Author(s):  
Paolo Castelnuovo ◽  
Iacopo Dallan ◽  
Manfred Tschabitscher
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Surgical Anatomy
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