Surgical Exposure of the Petrous Internal Carotid Artery: Practical Application for Skull Base Surgery

• Published in: The Laryngoscope Vol. 107; no. 7; pp. 967 - 976
• Main Authors: Dew, Leigh Anne, Shelton, Clough, Harnsberger, H. Ric, Thompson Jr, B. Gregory
• Format: Journal Article
• Language: English
• Published: Hoboken, NJ John Wiley & Sons, Inc 01-07-1997; Wiley-Blackwell
• Subjects: Biological and medical sciences; Cadaver; Carotid Artery, Internal - anatomy & histology; Carotid Artery, Internal - diagnostic imaging; Carotid Artery, Internal - surgery; Cephalometry; Cochlea - anatomy & histology; Cochlea - diagnostic imaging; Cochlea - injuries; Geniculate Ganglion - anatomy & histology; Humans; Intraoperative Care; Intraoperative Complications - prevention & control; Medical sciences; Neurosurgery; Osteotomy - instrumentation; Petrous Bone - anatomy & histology; Petrous Bone - diagnostic imaging; Preoperative Care; Safety; Skull Base - surgery; Skull, brain, vascular surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Temporal Bone - anatomy & histology; Temporal Bone - diagnostic imaging; Tomography, X-Ray Computed; Human; Internal carotid; Petrous bone; Radiodiagnosis; Anatomy; Treatment; Bypass; Surgery; Medical imagery; Computerized axial tomography; Limit; Technique; Comparative study
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1097/00005537-199707000-00026

When exposing the horizontal petrous carotid artery in preparation for intrapetrous carotid by‐pass, the surgeon has no definite landmarks to localize the perimeter of the cochlea. The results of this study provide a practical, consistent, and safe method to maximize carotid artery exposure while minimizing cochlear injury. We measured the carotid‐cochlea distance (mean, 4.3 mm) and the carotid‐cochlear angle (mean, 10.8°) in 33 temporal bones in which the extended middle fossa approach had been performed. We correlated this distance to the width of a Sheehy weapon knife, which can be easily measured intraoperatively. Twenty‐five temporal bones were imaged prior to surgical exposure using a new computed tomography (CT) protocol that can be used for preoperative assessment of the carotid‐cochlear anatomy. The carotid‐cochlea distance and carotid‐cochlear angle measured on CT are compared with postsurgical measurements.