KISEP Otology Korean J Otolaryngol 1999;42: 추체첨부의수술해부학적인지표 이원상 1 김지수 1 이호기 1 문성균 1 정인혁 2 Surgical Anatomical Landmarks for Petrous Apex Won-Sang

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1 KISEP Otology Korean J Otolaryngol 1999;42: 추체첨부의수술해부학적인지표 이원상 1 김지수 1 이호기 1 문성균 1 정인혁 2 Surgical Anatomical Landmarks for Petrous Apex Won-Sang Lee, MD 1, Jie-Soo Kim, MD 1, Ho-Ki Lee, MD 1, Sung-Kyun Moon, MD 1 and In-Hyuk Chung, MD 2 1 Department of Otorhinolaryngology, 2 Anatomy, College of Medicine, Yonsei University, Seoul, Korea ABSTRACT Background and ObjectivesAnatomical knowledge of the petrous apex is essential to otolaryngologist to explore the skull base lesions. This study was designed to investigate the surgical anatomy of the petrous apex and the middle cranial fossa. Materials and MethodsWe dissected 32 temporal bones in order to establish the anatomical relationships of petrous apex structures. We measured distances and angles between different structures so that surgeons can rely on to work in this area. ResultsThe results of the present study showed distances and angles of the different petrous apex structures. The angle between posterior point-foramen spinosum and porus was 90 degree. ConclusionWe could suggest the new indicators to identify the internal acoustic canal. Korean J Otolaryngol 1999;42: KEY WORDSSurgical landmarks Petrous apex Middle cranial fossa. 405

Fig. 1. Landmarks of middle cranial fossa at external surface of skull. APosterior point posterior root of zygomatic arch.

Landmarks of internal acoustic canal using external references. APosterior point. BMalleo-incudal joint. C Bill s bar. Fig. 3.

CPosterior margin of porus. DAnterior margin of porus. Fig. 4.

2 Fig. 1. Landmarks of middle cranial fossa at external surface of skull. APosterior point posterior root of zygomatic arch. BCImaginary coronal line of foramen spinosum. DEImaginary coronal line of anterior margin of foramen ovale. Fig. 2. Landmarks of internal acoustic canal using external references. APosterior point. BMalleo-incudal joint. C Bill s bar. Fig. 3. Landmarks of internal acoustic canal using internal and external references. APosterior point. BForamen spinosum. CPosterior margin of porus. DAnterior margin of porus. Fig. 4. Distances between foramen spinosum and foramen ovale and between foramen spinosum and foramen rotundum. AAnterior margin of foramen spinosum. BPosterior margin of foramen ovale. CPosterior margin of foramen rotundum. 406 Korean J Otolaryngol 1999;42:405-10

Measurement of Glasscock s triangle. AGeniculate ganglion. BCross point between GSPN and mandibular branch of trigeminal nerve.

3 외측지표를이용한방법 내측지표및외측지표를이용한방법 Fig. 5. Distances between GSPN and tensor tympani muscle and between GSPN and internal carotid artery. Shortest distance between greater superficial petrosal nerve GSPN and internal carotid artery. Distance between GSPN and tensor tympani muscle. A B Fig. 6. Measurement of Glasscock s triangle. AGeniculate ganglion. BCross point between GSPN and mandibular branch of trigeminal nerve. CPosterior margin of foramen ovale. Fig. 7. Alignment of both GSPN and tensor tympani muscle. A. Parallel between GSPN and tensor tympani muscle. B. Divergence between GSPN and tensor tympani muscle. 407

4 대추체신경, 내경동맥, 및고막긴장근사이의거리 슬신경절, 난원공, 대추체신경이삼차신경의하악분지와만나는곳사이의거리 Table 1. Landmarks of middle cranial fossa at external surface of skull mm * Posterior point-foramen spinosum Posterior point-foramen ovale *SDstandard deviation Table 2. Landmarks of internal acoustic canal using external references mm Posterior point-m-i joint* M-I joint-bill s bar *M-I jointmalleo-incudal joint Table 3. Landmarks of internal acoustic canal using internal and external references degree Angle between Mean Minimum Maximum SD Posterior point-foramen spinosum-ant.border of porus-foramen spinosum Posterior point-foramen spinosum-post.border of porus-foramen spinosum Table 4. Distances between foramen spinosum, foramen ovale, and foramen rotundum mm Foramen spinosum-foramen ovale Foramen spinosum-foramen rotundum Table 5. Distance between GSPN and tensor tympani muscle and GSPN and internal carotid artery mm GSPN-Internal carotid artery GSPN-Tensor tympani muscle Table 6. Measurements of Glasscock s triangle mm GSPN-Foramen ovale Geniculate ganglion-foramen ovale Geniculate ganglion-gspn Korean J Otolaryngol 1999;42:405-10

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6 REFERENCES 1) Kim YH, Kim HN, Kim GR, Chung IH. Surgical anatomy of the neurovascular complex of cerebellopontine angle in human cadavers. Korean J Otolaryngol ) House WF. Surgical exposure of the internal auditory canal and its contents through the middle cranial fossa. Laryngoscope ) Fisch U. Transtemporal surgery of the internal acoustic canal Report of 92 cases, tehnique, indications and results. Adv Oto-Rhino-Laryngol ) Garcia-Ibanez E, Garcia-Ibanez JL. Middle fossa vestibular neurectomya report of 373 cases. Otolaryngol Head Neck Surg ) Catalano PJ, Eden AR. An external reference to identify the internal auditory canal in middle fossa surgery. Otolaryngol Head Neck Surg ) Matsunaga T, Igarashi M, Kanzaki J. Landmark structures to approach the internal auditory canala dimensional study related to the middle cranial fossa approach. Acta Otolaryngol Stockh 1991Suppl ) Lee WS, Kim JS, Lee HK, Chung IH. Surgical landmarks for extended middle fossa approach. Korean J Otolaryngol ) Glasscock III ME, Smith PG, Whitaker SR. Management of aneurysms of the petrous portion of the internal carotid artery by resection and primary anastomosis. Laryngoscope ) Kawase T, Toya S, Shiobara R, Mine T. Transpetrosal approach for aneurysms of the lower basilar artery. J Neurosurg ) Kawase T, Shiobara R, Toya S. Anterior transpetrosal-transtentorial approach for sphenopetroclival meningiomassurgical method and results 10 patients. Neurosurgery ) Sekhar LN, Burgess J, Akin O. Anatomical study of the cavernous sinus emphasizing operative approaches and related vascular and neural reconstruction. Neurosurgery Korean J Otolaryngol 1999;42:405-10

KISEP Case Reports Korean J Otolaryngol 1999;42:232-6 경미로접근법으로제거한거대소뇌교각종양 4 예 박찬민 황보철 신종헌 손수준 Four Cases of Large Cerebellopontine Angle Tumors Remove

KISEP Case Reports Korean J Otolaryngol 1999;42:232-6 경미로접근법으로제거한거대소뇌교각종양 4 예 박찬민 황보철 신종헌 손수준 Four Cases of Large Cerebellopontine ngle Tumors Removed by Translabyrinthine pproach Chan Min Park, MD, Cheul