Three-dimensional imaging for the localization of related anatomical structures during surgery on the internal auditory canal

Abstract

Background The Fisch infra-temporal fossa approach (Fisch’s method), first proposed in 1970, is commonly used during internal auditory canal (IAC) surgery with an approach that advances through the middle cranial fossa. This study was designed to address the technical difficulties encountered in recognizing and localizing the arcuate eminence with respect to the superior semicircular canal (SSC). Methods Forty men and 40 women (18–57 years of age) without space-occupying lesions in the petrous part of the temporal bone were selected for the study. In total, 160 samples were obtained from both sides of the temporal bone. The temporal bone in these 160 samples was scanned using computed tomography, and a three-dimensional coordinate system was established to measure the three-dimensional coordinate values of structures adjacent to the arcuate eminence, the SSC, and the IAC. Results The results showed that the shape of the arcuate eminence is highly variable. Approximately 23.12% of samples had no obvious arcuate eminence, which prevented the use of Fisch’s method to localize the SSC. The arcuate eminence was difficult to identify in 37 samples. Conclusions Analysis samples showed that the SSC was located in a fan ring centered at the midpoint of the upper edge of the petrous portion of the temporal bone. The arcuate eminence did not correspond directly with the SSC, as the former was located posterolateral to the latter in 85.83% of samples. The angle between the SSC and the IAC ranged from 0° to 60° degrees, as reported previously by Fisch. However, the angle typically ranged from 10–30° in our study.

Transorbital and supraorbital uniportal multicorridor approach to the orbit, anterior, middle and posterior cranial fossa: Anatomic study

“…Once exposed, the Kawase's triangle is drilled with a 3 mm diamond burr in an anteroposterior direction from the trigeminal ganglion to the superificial inference of the internal acoustic canal, as described by Fisch; and in medio-lateral direction from the petrous ridge to GSPN overlying the horizontal petrous portion of internal carotid artery ( Guo et al, 2022 ) ( Fig. 7 A).…”