The temporal bone and transtemporal approaches
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The document discusses various surgical approaches to the temporal bone, including: 1. The anterior, posterior, superior, and inferior boundaries of the temporal bone. 2. Ten triangles of the temporal bone - four in the cavernous sinus and six in the middle fossa. 3. The Kawase vs modified Dolenc-Kawase approach - which differs in the drilling sequence and angle of approach. 4. Several cranial fossa approaches - simple middle cranial fossa, anterior petrosectomy, extended middle fossa, presigmoid, and various modifications. 5. Anatomic landmarks and surgical techniques for the postauricular transtemporal, combined presigmoid
The temporal bone and transtemporal approaches
- 1. The Temporal Bone And Transtemporal Approaches Dr. Shahnawaz Alam Guided by:-Dr. Vikas Chandra Jha HOD Neurosurgery Moderated by:-Dr. Saraj kumar Singh Asst.Prof. (Dept. of Neurosurgery)
- 2. 1. ANTERIOR a. GW OF SPHENOID BONE : SQUAMOUS PART b. ZYGOMATIC BONE: ZYGOMATIC PROCESS 2. POSTERIOR: OB 3. SUPERIOR: PB 4. INFERIOR: GLENOID CAVITY;MANDIBULAR CONDYLE
- 3. LATERAL VIEW; ENLARGED VIEW OF EAC
- 4. lateral surface of the temporal bone in the intact skull supra- and infratentorial areas while preserving the bone at the site of the sutures
- 9. Superior View Of The Temporal Bone And Infratemporal Fossa
- 10. SUPERIOR VIEW
- 11. POSTEREIOR VIEW
- 12. A close-up view of the jugular foramen * Jugulocarotid spine, < Cochlear aqueduct canal, > Jacobson’s nerve canal, AN Arnold’s nerve canal, D Dome of the jugular bulb, ICA Internal carotid artery canal, IPS Groove for the inferior petrosal sinus, SP Styloid process
- 13. 10 Triangles = 4 Cavernous Sinus Triangles + 6 Middle Fossa Triangles 4 Cavernous Sinus Triangles 1. Clinoidal (Anteromedial) Triangle 2. Oculomotor (Medial or Hakuba's) Triangle 3. Supratrochlear (Paramedian) Triangle 4. Parkinson's (Infratrochlear) Triangle 6 Middle Fossa Triangles 1. Anteromedial (Mullan's) Triangle 2. Anterolateral Triangle 3. Posterolateral (Glasscock's) Triangle 4. Posteromedial (Kawase's) Triangle 5. Inferolateral paraclinoid Triangle 6. Inferomedial paraclinoid Triangle
- 15. Kawase Vs The Modified Dolenc-Kawase Approach 60◦ •ANTERIOR- V3 POSTERIOR EDGE •POSTERIOR- AE •MEDIAL- PETROUS EDGE •LATERAL- GSPN DRILLING SEQUENCE: Safe Area (anteromedial)/ under GSPN/ anterior to IAC/ T-shaped dural incision
- 20. * * STA
- 21. The first landmark to be identified is the arcuate eminence (AE) As dural elevation advances anteriorly, the middle meningeal artery (MMA) is identified next The greater petrosal nerve (GPN) is identified next Middle Cranial Fossa Approaches 60◦
- 22. Simple Middle Cranial Fossa Approach gray color: amount of petrous bone removed; only the bone overlying IAC removed Anterior Petrosectomy And Extended Middle Fossa Approach IAC Internal auditory canal, ICA Internal carotid artery, SPS Superior petrosal sinus, SSC Superior semicircular canal
- 26. Preauricular Subtemporal-infratemporal Fossa Approach
- 30. The triangle of attack is created; MCF level of the middle cranial fossa, SS level of the sigmoid sinus, T tangent to the posterior canal wall The minimal/extended mastoidectomy - antrum opened- The digastric ridge DR identified The mastoid segment of the facial nerve (^) b/w DR & LSC has been well skeletonized
- 33. VARIOUS MODIFICATIONS OF PRESIGMOID APPROACHES
- 37. Anatomic Basis Of The Postauricular Transtemporal Approach
- 43. Combined Presigmoid And Far-Lateral Approach
- 46. Combined Transmastoid Middle Cranial Fossa Approach DR Digastric ridge, I Incus, LSC Lateral semicircular canal, M Malleus, SS Sigmoid sinus
- 47. Takeshi Kawase Professor and Chairman, Department of Neurosurgery, Keio University School of Medicine, Japan