Avulsion rupture of the internal auditory artery during operations in the cerebellopontine angle: a study in monkeys

The effect of manipulations in the cerebellopontine (CP) angle on the cochlear nerve was studied in 12 rhesus monkeys to elucidate how surgical procedures in the CP angle may affect the peripheral auditory system. Brain stem auditory evoked potentials and compound action potentials from the cochlear nerve were recorded throughout the experiments and were studied to determine the level of injury to the cochlear nerve. After the manipulations, the animals were perfused with fixatives and their temporal bones were removed and examined histologically. The monkeys showed electrophysiological changes similar to those observed in humans as a result of surgical manipulations in the CP angle. Avulsions of the internal auditory artery and cochlear nerve fibers at the area cribrosa were the most common histological findings. The auditory evoked potentials were suddenly and irreversibly lost during the manipulations in 3 monkeys, and hemorrhagic foci were identified histologically in these animals at the fundus of the internal auditory canal (the area cribrosa). No morphological changes at locations other than the area cribrosa were identified in these 3 monkeys. The results of this study indicate that injury to the internal auditory artery at the area cribrosa may play an important role in the abrupt loss of hearing experienced by some patients while they are undergoing operations in the CP angle. This study also led to speculation regarding the possible existence of collateral circulation to the cochlea as a factor in injury to the internal auditory artery during acoustic neurinoma operations.