the cerebellopontine angle is actually a space stuffed with spinal fluid. it's the brain stem as its medial boundary, the cerebellum as its roof and posterior boundary, and also the posterior surface area of your temporal bone as its lateral boundary. the flooring of your cerebellopontine angle is formed through the decrease cranial nerves (ix-xi) and their surrounding arachnoid investments. the flocculus of the cerebellum may possibly lie inside the cerebellopontine angle and will be carefully associated with cranial nerves viii and vii because they cross the cerebellopontine angle to enter the inner auditory canal.
the facial nerve arises 2-3 mm anterior to the root entry zone from the vestibulocochlear nerve. the foramen of luschka (ie, the opening of your lateral recess with the fourth ventricle) is located just inferior and posterior to the root entry zones with the facial and vestibulocochlear nerve. a tuft of choroid plexus can frequently be observed extruding from it. inferior and a bit anterior to the foramen of luschka is the olive, and just posterior to the olive lie the rootlets of origin for cranial nerves ix, x, and xi. the hypoglossal nerve exits the brain stem through a series of small rootlets anterior to the olive.
vascular structures inside of the cerebellopontine angle
the most important vascular structure within the cerebellopontine angle is the anterior inferior cerebellar artery (aica). it arises most commonly as a single trunk from the basilar artery but can arise as 2 separate branches. in rare cases, it originates as a branch from the posterior inferior cerebellar artery (pica). as the aica moves from anterior to posterior,
Microsoft Office 2010 Professional Plus, it first follows the ventral surface area of the brain stem, but inside the cerebellopontine angle it takes a long loop laterally to the porus acousticus. in 15-20% of cases, the aica actually passes into the lumen with the internal auditory canal before turning back on itself toward the posterior surface area with the brain stem. the aica can thus be divided into the premeatal, meatal, and postmeatal segments.
the main branch with the aica passes over cranial nerves vii and viii in only 10% of cases. the remainder from the time, it either passes below the vii and viii cranial nerves or, in 25-50% of individuals, actually passes between them. three branches that regularly arise from the meatal segment of the aica can be identified. small perforating arteries supply blood to the brain stem. the subarcuate artery passes through the subarcuate fossa into the posterior floor with the temporal bone, as well as the third regular branch is the internal auditory artery (labyrinthine artery). cranial nerves vii and viii receive their blood supply from small branches of aica.
two venous structures must be kept in mind during surgical procedures involving the cerebellopontine angle. the petrosal vein (of dandy) brings returning venous blood from the cerebellum and lateral brain stem to the superior or inferior petrosal sinus. it is generally encountered in the area of the trigeminal nerve anterior to the porus acousticus. the petrosal vein often carries enough venous blood that its obstruction can lead to venous infarction and cerebellar edema, and it should be preserved if at all possible. additional venous blood reaches the superior petrosal sinus through a series of bridging veins that cross the cerebellopontine angle. although every attempt should be made to preserve these veins, their sacrifice is generally inconsequential.
the vein of labbé carries returning venous blood from the inferior and lateral floor of your temporal lobe to the superior petrosal sinus,
Office Professional Plus, tentorial venous lakes, or the transverse sinus. its configuration and anatomy is quite variable. however, obstruction,
Office Home And Student 2010, obliteration, or occlusion from the superior petrosal sinus may possibly, in some cases,
Office 2007 Ultimate, result in occlusion with the vein of labbé. sudden occlusion from the vein of labbé carries with it high risk of venous infarction from the temporal lobe and rapid life-threatening cerebral edema.
nerves
the facial nerve leaves the brain stem anterior to the foramen of luschka. as it leaves the brain stem, the fibers are sheathed in oligodendroglia derived from the central nervous system. in a few millimeters of leaving the brain stem, however, the nerve loses its oligodendroglial ensheathment and becomes ensheathed instead by schwann cells. throughout the remainder of its peripheral course, it remains inside its schwann cell investment. it passes directly across the cerebellopontine angle for about 15 mm,
Microsoft Office Ultimate 2007, accompanied through the vestibulocochlear nerve. it consistently enters the internal auditory canal by crossing the anterior superior margin with the porus acusticus.
the vestibulocochlear nerve arises from the brainstem slightly posterior to the facial nerve. it remains sheathed in oligodendroglia for approximately 15 mm (almost to the point at which it passes into the inner auditory canal). it has the longest oligodendroglial investment of any peripheral nerve. the junction between oligodendroglia and schwann cells (ie, the obersteiner-redlich zone) occurs just medial to the porus acousticus. because acoustic neuromas arise from schwann cells, they arise most commonly inside of the most lateral portions from the cerebellopontine angle or the inner auditory canal.
the nervus intermedius (nerve of wrisberg) leaves the brain stem together with the vestibulocochlear nerve. at some point inside of the cerebellopontine angle, the nervus intermedius crosses over to become connected with the facial nerve. it may do so as several separate rootlets. the point where the nervus intermedius crosses to become related with the facial nerve shows considerably variation, but in 22% of individuals, it is adherent to the vestibulocochlear nerve for 14 mm or more. as the vestibulocochlear and facial nerve reach the porus acousticus (medial opening of the internal auditory canal) they pass together with the nervus intermedius and sometimes a loop of aica.
internal auditory canal
the inner auditory canal is approximately 8.5 mm in length (range 5.5-10.5 mm), lined with dura, and stuffed with spinal fluid. its medial end is oval in shape and is referred to as the porus acousticus. its lateral end is a complicated structure referred to as the fundus or lamina cribrosa. the fundus is divided into a superior and inferior half through the transverse crest. the upper half is further subdivided into an anterior and posterior segment by a vertical crest, often referred to as bill’s bar, named after william house, who popularized its importance as a surgical landmark. the vertical crest separates the macula cribrosa superior, a series of very small openings through which the terminal fibers with the vestibular nerve pass in order to reach the cupula from the superior semicircular canal, from the meatal foramen, which marks the point at which the facial nerve leaves the internal auditory canal and enters the fallopian canal as the labyrinthine segment.
because the most lateral portion with the internal auditory canal is 4-5 mm inferior to the level of your geniculate ganglion, the labyrinthine segment from the facial nerve must take a vertically oriented course upward to reach it. the labyrinthine segment could be less than a millimeter wide as it passes between the cochlea and the anterior end from the superior semicircular canal. the inferior portion from the fundus is a single oval-shaped space, the anterior portion of which is occupied by a rounded depression (tractus spiralis foraminosus) filled up with small openings to accommodate the terminal branches with the cochlear nerve. the posterior portion is filled with a macula crista inferior through which pass the terminal ends of your inferior vestibular nerve.
temporal bone
the anatomy with the superior floor from the temporal bone must be mastered if middle fossa approaches are to be undertaken successfully. laterally, the irregular superior surface of the temporal bone transitions relatively smoothly to the temporal squamosa. the free edge of your tentorium as well as the superior petrosal sinus attach to the medial edge of your superior surface area from the temporal bone. the arcuate eminence, a bony prominence that is perpendicular to the petrous ridge and lies two centimeters medial to the squamous temporal bone, often overlies the superior semicircular canal. the arcuate eminence is often difficult to identify, especially in well-pneumatized temporal bones.
the geniculate ganglion generally lies in the substance of the temporal bone just medial to and a few millimeters anterior to the head of the malleus. the geniculate ganglion may possibly be dehiscent, or alternatively, it may possibly lie several millimeters beneath the superior surface area with the bone. the head of the malleus is generally easy to identify if the thin bone from the tegmen tympani is removed so as to enter into the middle ear room. in difficult surgical situations, the head of the malleus can be used to identify the geniculate ganglion. the greater superficial petrosal nerve originates from the geniculate ganglion and courses anteromedially, passing over the superior surface area of your temporal bone at the facial hiatus. the facial hiatus is generally 4-8 mm anterior to the geniculate ganglion. the greater superficial petrosal nerve can generally be identified in this area. it can then be followed retrograde to the geniculate ganglion.
the middle meningeal artery and linked veins traverse the foramen spinosum, which is located approximately 1 cm anterolaterally to the greater superficial petrosal nerve. the mandibular division with the trigeminal nerve traverses the foramen ovale, which lies a few millimeters anterior and medial to the foramen spinosum. the horizontal portion of the carotid canal courses through the anterior temporal bone medial to the foramen spinosum and foramen ovale. the cochlea cannot be identified from the surface appearance with the superior temporal bone. it lies just anterior and inferior to the labyrinthine segment with the facial nerve but is deep to the geniculate ganglion.
Office Home And Student 2010 skull base, acoustic
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