ICAR: endoscopic skull‐base surgery

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Anatomical study of the pterygopalatine fossa using an endoscopic endonasal approach: spatial relations and distances between surgical landmarks

Object The pterygopalatine fossa is an area that lies deep within the skull base. The recent extensive use of the endoscopic endonasal approach has provided neurosurgeons with a method to reach various areas of the skull base through a less invasive approach than traditional transcranial or transfacial approaches. This study aims to provide neurosurgeons with new data concerning direct endoscopic measurements and precise anatomical topography features of the pterygopalatine fossa. Methods An anatomical dissection of six fixed cadaver heads (12 pterygopalatine fossae) was performed to analyze spatial relationships and distances between the most important neurovascular structures in this region, and to estimate the size of the endoscopic surgical field for operations in this area. The endoscopic endonasal approach offers direct access to the pterygopalatine fossa through its anteromedial walls. Conclusions Using an endoscopic endonasal approach makes it possible to identify all of the anatomical landmarks of the pterygopalatine fossa and almost all of the contiguous skull base areas

Suboccipital Retrosigmoid Surgical Approach For Internal Auditory Canal––A Morphometric Anatomical Study on Dry Human Temporal Bones

Suboccipital retrosigmoid craniotomy with removal of posterior wall of internal auditory canal is preferred by many surgeons operating on acoustic neuromas, as it is a simple and safe approach. To study the topographic landmarks of the posterior surface of the temporal bone. We studied the surgical anatomy of 224 dry adult human temporal bones, measured the various distances on posterior wall of petrous bone relevant for suboccipital surgical approach to internal auditory canal. The internal auditory canal (IAC) lies within 32–44 mm from posterior wall of sigmoid sulcus and within 3–8 mm from the superior border of petrous bone. The point corresponding to highest point of jugular bulb was found between 4 and 9 mm away from the inferior border of IAC. The maximum distance found between bony orifice of vestibular aqueduct and IAC was 14 mm and the minimum distance was 6 mm.The vertical diameter of IAC ranged between 3 and 7 mm. These parameters may help the surgeons for better exposure of internal auditory canal and for avoiding damage to vital surrounding structures