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Three-dimensional image for the middle fossa approach and its anatomical considerations
A Tsunoda1, A Komatsuzaki, M Kobayashi
1Department of Otolaryngology, Tokyo Medical and Dental University, Tokyo, Japan. atsunoda@mac.com
Objective:
To investigate the usefulness and significance of three-dimensional images in the middle cranial fossa approach.
Study Design:
Retrospective study.
Method:
Three-dimensional images of 12 patients with acoustic neuromas were made for surgical guidance. An image showing an ideal surgical view was prepared, which showed no overlap between the labyrinthine bone and internal auditory canal (IAC) with a slight gap between them. The IAC was located and opened referring to this image.
Results:
Directions of the images in the ideal surgical view were anterior from lateral position in all cases. Viewing toward the vestibule, angle from lateral plane was 24 degrees +/- 12 degrees (mean +/- standard deviation). In 11 of 12 patients, the IAC was safely opened; in one patient the IAC could not be opened because of bleeding. Overall hearing preservation rate was 82%.
Conclusion:
Our method facilitated not only in the identification of the IAC but also in avoiding inner ear damage. Our data indicated that the center of craniotomy should be made anterior to the external auditory canal and surgery should be viewed from an anterolateral position for a safe procedure.