Exposure of the Petrous Segment of the Internal Carotid Artery Through the Extradural Subtemporal Middle Cranial Fossa Approach: A Systematic Anatomical Study

Abstract

The relationships between the horizontal segment ofthe internal carotid artery (ICA) The horizontal segment of the petrous in-ticular, the relationship among the structures of the ternal carotid artery (ICA) can be exposed through petrous apex must be understood. We performed a the extradural subtemporal middle cranial fossa ap-systematic anatomical study to determine a safe proach,116 which requires good knowledge of the and effective method for exposing the ICA anatomy of the petrous apex.1,2,5-8l10l2-15,17 In par-through the above approach.

Maximizing the Petroclival Region Exposure Via a Suboccipital Retrosigmoid Approach

“…20 The greater superficial petrosal nerve originating from the anterior aspect of the geniculate ganglion usually travels anteromedial above the genu and the horizontal segment of the IICA. 20 23 ; others, shorter lengths 22,24,25 ; and others, longer lengths. 21 The diameter of the IICA was constant in all of its 3 segments, being measured at 5.20 mm (range, 4.00-8.00 mm).…”

“…20 Other authors reported similar data. 21,23,24 Since the seminal studies of Glasscock and Paullus, numerous studies have dealt with the surgical management of skull base lesions involving the IICA via the middle fossa approach or its variants. The complex anatomy of this area led to the definition of geometrical landmarks such as the Glasscock triangle and the middle fossa rhomboid for guiding the approach to these lesions while minimizing possible neurovascular complications.…”

“…Table 3 compares our results on the topographic anatomy of the IICA with those reported by previous studies. [20][21][22][23][24][25][26][27][28] DISCUSSION Surgical management of petrous and petroclival skull base lesions is challenging and is usually accomplished through complex and maximally invasive routes.…”

Intrapetrous Internal Carotid Artery: Evaluation of Exposure, Mobilization and Surgical Maneuvers Feasibility from a Retrosigmoid Approach in a Cadaveric Model

“…Measurements reported in middle fossa approach anatomic studies and radiologic studies [20][21][22] are shown and compared in Table 1.…”

Lateral transzygomatic middle fossa approach and its extensions: Surgical technique and 3D anatomy

“…The horizontal portion of the internal carotid artery (ICA) may be exposed by drilling the bone just inferomedial to the GSPN (Fig. 4b), but may be dehiscent in 20-63% of cases [6,50,53].…”