PDF herunterladen
CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol 2021; 25(03): e392-e398
DOI: 10.1055/s-0040-1712105
Original Research

Middle Cranial Fossa Approach: The Incudomalleolar Joint as a Reliable Landmark

Syed Salman Hashmi 
1   Department of Otolaryngology, Baqai Medical University, Karachi, Sindh, Pakistan
,
Juan Carlos Izquierdo 
2   Department of Surgery, Division of Otolaryngology, Universidad Nacional de Colombia, Bogota, Colombia
,
Susan D. Emmett 
3   Department of Head and Neck Surgery and Communication Sciences, School of Medicine, Duke University , Durham, NC, United States
4   Duke Global Health Institute, Duke University, Durham, NC, United States
,
Thomas Edwin Linder 
5   Department of Otorhinolaryngology, Luzerner Kantonsspital, Luzern, Switzerland
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

Abstract

Introduction The middle cranial fossa approach is performed by fewer neurotologists owing to a reduced number of indications. Consistent landmarks are mandatory to guide the surgeon in a narrow field.

Objectives We have evaluated the incus and malleus head and the incudomalleal joint (IMJ) as a key landmark for identifying the superior semicircular canal (SSC) and to get oriented along the floor of the middle cranial fossa.

Methods A combination of 20 temporal bone dissections and CT imaging were utilized to test and describe these landmarks.

Results The blue line of the SSC is consistently identified along the prolongation of a virtual line through the IMJ and the angulation toward the root of zygoma. The mean distance from the zygoma toward the IMJ ranged from 1.60 to 1.90cm. Once the IMJ was identified, the blue line of the SSC was consistently found along the virtual line through the IMJ within 5 to 9mm.

Conclusions The IMJ is a safe and consistent anatomical marker in the surgical approach to the middle cranial fossa floor. Opening the tegmen 1.5 to 2cm medial to the root of the zygoma and identifying the joint allows to trace a virtual line toward the SSC within 5 to 9mm. Knowledge of the close relationship between the direction of the IMJ and the superior canal can be used in all transtemporal approaches, thus orienting the surgeon in a rather narrow field with limited retraction of the dura and brain.

Keywords

middle cranial fossa surgery - transtemporal-supralabyrinthine approach - superior semicircular dehiscence - arcuate eminence


Publikationsverlauf

Eingereicht: 03. November 2019

Angenommen: 19. März 2020

Artikel online veröffentlicht:
24. September 2020

© 2020. Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Yetiser S. Total facial nerve decompression for severe traumatic facial nerve paralysis: a review of 10 cases. Int J of Otolaryngol. Volume 2012, 2012:607359. doi:10.1155/2012/607359. Epub 2011 Nov 20
  • 2 Domenech Juan I, Cruz Toro P, Callejo Castillo Á, Moya R, Merán Gil JL, Bartel R. Middle fossa approach: Applications in temporal bone lesions. Abordaje por fosa media, aplicaciones en lesiones del hueso temporal. Acta Otorrinolaringol Esp. 2016;67(04):233–238. doi:10.1016/j.otorri.2015.06.001
  • 3 Peng KA, Lekovic GP, Wilkinson EP. Pearls for the middle fossa approach in acoustic neuroma surgery. Curr Opin Otolaryngol Head Neck Surg 2018; 26 (05) 276-279
    CrossrefPubMedGoogle Scholar
  • 4 Mikulec AA, Poe DS, McKenna MJ. Operative management of superior semicircular canal dehiscence. Laryngoscope 2005; 115 (03) 501-507
    CrossrefPubMedGoogle Scholar
  • 5 Fisch U. Transtemporal surgery of the internal auditory canal. Transtemporal Surgery of the Internal Auditory Canal. 17: Karger Publishers; 1970: 203-240
    Google Scholar
  • 6 Fisch U, Mattox D. Microsurgery of the skull base. Thieme; 1988
    Google Scholar
  • 7 Tsunoda A, Kimura Y, Sumi T, Komatsuzaki A, Sato T. The arcuate eminence is not a protrusion of the superior semi-circular canal but a trace of sulcus on the temporal lobe. J Laryngol Otol 2000; 114 (05) 339-344
    CrossrefPubMedGoogle Scholar
  • 8 Seo Y, Ito T, Sasaki T, Nakagawara J, Nakamura H. Assessment of the anatomical relationship between the arcuate eminence and superior semicircular canal by computed tomography. Neurol Med Chir (Tokyo) 2007; 47 (08) 335-339 , discussion 339–340
    CrossrefPubMedGoogle Scholar
  • 9 El Hadi T, Sorrentino T, Calmels M-N, Fraysse B, Deguine O, Marx M. Spontaneous tegmen defect and semicircular canal dehiscence: same etiopathogenic entity?. Otol Neurotol 2012; 33 (04) 591-595
    CrossrefPubMedGoogle Scholar
  • 10 Patel NS, Hunter JB, O'Connell BP, Wanna GB, Carlson ML. O'ConnellBP, WannaGB, CarlsonML. An easy and reliable method to locate the dehiscence during middle fossa superior canal dehiscence surgery: it is a (C) inch. Otol Neurotol 2016; 37 (08) 1092-1095
    CrossrefPubMedGoogle Scholar
  • 11 Maina R, Ducati A, Lanzino G. The middle cranial fossa: morphometric study and surgical considerations. Skull Base 2007; 17 (06) 395-403
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 12 Beckett JS, Chung LK, Lagman C. et al. A Method of locating the dehiscence during middle fossa approach for superior semicircular canal dehiscence surgery. J Neurol Surg B Skull Base 2017; 78 (04) 353-358
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 13 Sennaroglu L, Slattery III WH. Petrous anatomy for middle fossa approach. Laryngoscope 2003; 113 (02) 332-342
    CrossrefPubMedGoogle Scholar
  • 14 Cokkeser Y, Aristegui M, Naguib MB, Saleh E, Taibah AK, Sanna M. Identification of internal acoustic canal in the middle cranial fossa approach: a safe technique. Otolaryngol Head Neck Surg 2001; 124 (01) 94-98
    CrossrefPubMedGoogle Scholar
  • 15 Garcia-Ibanez E, Garcia-Ibanez JL. Middle fossa vestibular neurectomy: a report of 373 cases. Otolaryngol Head Neck Surg 1980; 88 (04) 486-490
    CrossrefPubMedGoogle Scholar
  • 16 House WF, Shelton C. Middle fossa approach for acoustic tumor removal. 1992. Neurosurg Clin N Am 2008; 19 (02) 279-288 , vi vi
    CrossrefPubMedGoogle Scholar