INTRODUCTION
ANATOMY AND SURGICAL APPROACHES OF THE TEMPORAL BONE AND ADJACENT AREAS Neurosurgery 61:S4-1, 2007
T
DOI: 10.1227/01.NEU.0000280027.92382.2B
he temporal bone is the most complicated osseous structure in the human body. Five parts participate in its formation. The facial and carotid canals in the temporal bone are the longest canals of passage of any cranial nerve or artery through the cranium. This complexity is further increased by the genus, and bends in the facial nerve and carotid artery within the temporal bone. The presence of the delicate cochlear and vestibular membranes within the temporal bone makes it the only bone that houses the end organs of a cranial nerve. It also houses the complicated mechanism for transmitting sounds from the outward world to the inner ear. The fact that the temporal bone faces the middle and posterior cranial fossa and also has lateral and lower surfaces yields the potential for multiple complex surgical routes to the temporal bone, and through it to deeper areas. It is the focus of more surgical routes and approaches than any other bone in the cranium. The delicate neural, vascular, and transmission systems within the bone add to the complexity of these surgical approaches and provide a special challenge in dealing with lesions in the area. This work, done with many of our research fellows, represents knowledge gained from nearly five decades of the study of microsurgical anatomy. We hope that the illustrations in three dimensions will aid all who deal with this complicated and delicate anatomy. Our previous article (Chapter 1) on the temporal bone was included as a starting point because it provides an up-to-date two-dimensional description of the anatomy and approaches to the temporal bone (1). Additional information on the surrounding area will be found in the volume Cranial Anatomy and Operative Approaches published by NEUROSURGERY (2). The three-dimensional (3D) part begins with a review of the osseous relationships and proceeds through the anatomy and surgical approaches directed to and through the temporal bone from the middle and posterior fossa and laterally through the mastoid. This is followed by sections related to the exposures directed along the margins of the temporal bone, which include the far lateral and transcondylar approaches and the approaches to the jugular foramen and fourth ventricle. Each of the latter sections is preceded by a short description of the approach. The pages with the 3D illustrations are to be viewed with the colored glasses. On the lower right, below the large 3D illustration, is a two-dimensional illustration with labels guiding the viewer to the important structures in the area. Each illustration is followed by a short legend. The 3D illustrations are to be viewed with the blue lens of the colored glasses placed in front
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of the right eye and the red lens in front of the left eye. Some of the cardboard glasses can be bent so the red and blue are reversed with a resulting loss of 3D viewing. This volume is dedicated to the fellows who have labored in our microsurgery laboratory beginning more than 40 years ago. Each fellow has been challenged to improve and build upon the efforts of the previous fellow. Several dozen fellows, beginning with Shigeaki Kobayashi in 1966, have made contributions to our knowledge of the temporal bone and surrounding areas. Special thanks go to Robin Barry, who has worked with us for more than two decades and who aligned all the pictures for 3D images, and to Laura Dickinson, who has labored over this manuscript. Capturing 3D images of the quality presented here requires careful preparation of the specimen and meticulous dissection, followed by the even greater challenge of obtaining satisfactory 3D images. Obtaining excellent specimens, completing meticulous specimen preparation, and combining that with surgically precise dissections, and outstanding two- and 3D photography is a rare achievement. We hope this work will enhance the reader’s understanding of this complex area and that it will result in accurate, gentle, and safe operative procedures for patients requiring surgery in this delicate area. This work is dedicated to the microsurgery fellows at the University of Florida who, for more than 40 years, have taught me so much about microsurgical anatomy and the temporal bone. Hiroshi Abe, Japan Hajime Arai, Japan Allen S. Boyd, Jr., Tennessee Robert Buza, Oregon Alvaro Campero, Argentina Alberto C. Cardoso, Brazil Christopher C. Carver, California Patrick Chaynes, France Chanyoung Choi, Korea Evandro de Oliveira, Brazil Hatem El Khouly, Egypt W. Frank Emmons, Washington J. Paul Ferguson, Georgia Juan C. Fernandez-Miranda, Spain Andrew D. Fine, Florida Brandon Fradd, Florida Kiyotaka Fujii, Japan Yutaka Fukushima, Japan Adriano Garcia-Scaff, Brazil
VOLUME 61 | NUMBER 4 | OCTOBER 2007 SUPPLEMENT 4 | S4-1
RHOTON
Hirohiko Gibo, Japan John L. Grant, Virginia Kristinn Gudmundsson, Iceland David G. Hardy, England Frank S. Harris, Texas Tsutomu Hitotsumatsu, Japan Takuya Inoue, Japan Tooru Inoue, Japan Yukinari Kakizawa, Japan Toshiro Katsuta, Japan Masatou Kawashima, Japan Chang Jin Kim, South Korea Robert S. Knego, Florida Shigeaki Kobayashi, Japan Chae Heuck Lee, South Korea Xiao-Yong Li, China William Lineaweaver, California J. Richard Lister, Florida Qing Liang Liu, China Jack E. Maniscalco, Florida Richard G. Martin, Alabama Carolina Martins, Brazil Haruo Matsuno, Japan Toshio Matsushima, Japan J. Robert Mozingo, deceased Hiroshi Muratani, Japan Antonio C.M. Mussi, Brazil Shinji Nagata, Japan Yoshihiro Natori, Japan Kazunari Oka, Japan Michio Ono, Japan
Shigeyuki Osawa, Japan T. Glenn Pait, Arkansas Wayne S. Paullus, Texas David Perlmutter, Florida Mark Renfro, Texas Wade H. Renn, Georgia Saran S. Rosner, New York Pablo Rubino, Argentina Naokatsu Saeki, Japan Shuji Sakata, Japan Eduardo R. Seoane, Argentina Xiang-en Shi, China Satoru Shimizu, Japan Ryusui Tanaka, Japan Necmettin Tanriover, Turkey Helder Tedeschi, Brazil Erdener Timurkaynak, Turkey Xiaoguang Tong, China Satoshi Tsutsumi, Japan Jay Ulm, Florida Hung T. Wen, Brazil C.J. Whang, South Korea Isao Yamamoto, Japan Alexandre Yasuda, Brazil Nobutaka Yoshioka, Japan Arnold A. Zeal, Florida 1. Rhoton AL Jr: The temporal bone and transtemporal approaches. Neurosurgery 47 [Suppl 3]:S211–S265, 2000. 2. Rhoton AL Jr: Cranial Anatomy and Surgical Approaches. Baltimore, Lippincott Williams & Wilkins, 2003.
From Pernkopf E, Ferner H: Atlas of Topographical and Applied Human Anatomy. Philadelphia, W.B. Saunders Company, 1963.
