The Experts below are selected from a list of 321 Experts worldwide ranked by ideXlab platform
Robert Sean Miller - One of the best experts on this subject based on the ideXlab platform.
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image guided localization of the internal auditory canal via the middle cranial fossa approach
Otolaryngology-Head and Neck Surgery, 2006Co-Authors: Robert Sean Miller, George T Hashisaki, Bradley W KesserAbstract:OBJECTIVE: We sought to determine the accuracy of an electromagnetic image guidance surgical navigation system in localizing the midpoint of the internal auditory canal (IAC) and other structures of the temporal bone through the middle cranial fossa approach. MATERIALS AND METHODS: Seven fresh cadaveric whole heads were dissected via a middle cranial fossa approach. High-resolution CT scans were used with an InstaTrak 3500 Plus electromagnetic image guidance system (General Electric, Fairfield, CT). We evaluated the accuracy of identifying several middle cranial fossa landmarks including the midpoint of the IAC; the labyrinthine segment of the facial nerve; and the arcuate eminence, the carotid artery, and Foramen Spinosum. RESULTS: We were able to identify the middle of the IAC within 2.31 mm (range 0.65-7.52 mm, SD 2.39 mm). The arcuate eminence could be identified within 1.86 mm (range 1.49-2.37 mm, SD 0.36 mm). We noted some interference when the handpiece was within 6 to 8 cm of the microscope. CONCLUSION: Although computer-aided navigational tools are no substitute for thorough knowledge of temporal bone anatomy, we found the InstaTrak system reliable in identifying the midpoint of the IAC to within 2.4 mm through a middle fossa approach.
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The superior petrosal triangle as a constant anatomical landmark for subtemporal middle fossa orientation.
The Laryngoscope, 2003Co-Authors: Robert Sean Miller, Myles L. PensakAbstract:Objectives/Hypothesis: Anatomical landmarks including the arcuate eminence and the superficial petrosal nerve serve as orienting landmarks for middle fossa dissection. However, because of considerable variation among patients, these landmarks are not always readily identifiable. We expand on a previously described method for identifying the head of the malleus as a constant anatomical landmark to optimize exposure when employing a middle fossa approach. Methods: We completed an anatomical study using 10 preserved human cadaveric temporal bones to define the anatomical relationship among the root of the zygoma, the posterior-lateral lip of the Foramen Spinosum, and the bony tegmen over the head of the malleus. Subsequently, 5 fresh whole human cadaveric heads (10 temporal bones) were dissected using a surgically oriented anterior petrosectomy-middle fossa approach to evaluate the consistency of localizing the head of the malleus. Results: We defined the superior petrosal triangle as a stable anatomical relationship. Our cadaveric data demonstrated that the distance from the root of the zygoma to the head of the malleus was 18.7 mm (SD = 1.7 mm) and the distance from the Foramen Spinosum to the head of the malleus was 19.2 mm (SD = 1.0 mm). The intersection of an arc transcribed 19 mm from the root of the zygoma and an arc transcribed 19 mm from the Foramen Spinosum localized the head of the malleus within 2.5 mm (SD = 2.4 mm). Conclusions: The landmarks defined by the superior petrosal triangle represent a means to localize the bony tegmen over the head of the malleus. Identification of the head of the malleus as a landmark in middle fossa surgery when other landmarks are not recognizable optimizes patient safety and surgeon confidence during complex surgical procedures.
Myles L. Pensak - One of the best experts on this subject based on the ideXlab platform.
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The superior petrosal triangle as a constant anatomical landmark for subtemporal middle fossa orientation.
The Laryngoscope, 2003Co-Authors: Robert Sean Miller, Myles L. PensakAbstract:Objectives/Hypothesis: Anatomical landmarks including the arcuate eminence and the superficial petrosal nerve serve as orienting landmarks for middle fossa dissection. However, because of considerable variation among patients, these landmarks are not always readily identifiable. We expand on a previously described method for identifying the head of the malleus as a constant anatomical landmark to optimize exposure when employing a middle fossa approach. Methods: We completed an anatomical study using 10 preserved human cadaveric temporal bones to define the anatomical relationship among the root of the zygoma, the posterior-lateral lip of the Foramen Spinosum, and the bony tegmen over the head of the malleus. Subsequently, 5 fresh whole human cadaveric heads (10 temporal bones) were dissected using a surgically oriented anterior petrosectomy-middle fossa approach to evaluate the consistency of localizing the head of the malleus. Results: We defined the superior petrosal triangle as a stable anatomical relationship. Our cadaveric data demonstrated that the distance from the root of the zygoma to the head of the malleus was 18.7 mm (SD = 1.7 mm) and the distance from the Foramen Spinosum to the head of the malleus was 19.2 mm (SD = 1.0 mm). The intersection of an arc transcribed 19 mm from the root of the zygoma and an arc transcribed 19 mm from the Foramen Spinosum localized the head of the malleus within 2.5 mm (SD = 2.4 mm). Conclusions: The landmarks defined by the superior petrosal triangle represent a means to localize the bony tegmen over the head of the malleus. Identification of the head of the malleus as a landmark in middle fossa surgery when other landmarks are not recognizable optimizes patient safety and surgeon confidence during complex surgical procedures.
Albert L. Rhoton - One of the best experts on this subject based on the ideXlab platform.
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blood supply of the facial nerve in the middle fossa the petrosal artery
Neurosurgery, 2008Co-Authors: Hatem Elkhouly, Juan C Fernandezmiranda, Albert L. RhotonAbstract:OBJECTIVE To define the arterial supply to the facial nerve that crosses the floor of the middle cranial fossa. METHODS Twenty-five middle fossae from adult cadaveric-injected specimens were examined under 3 to 40x magnification. RESULTS The petrosal branch of the middle meningeal artery is the sole source of supply that crossed the floor of the middle fossa to irrigate the facial nerve. The petrosal artery usually arises from the first 10-mm segment of the middle meningeal artery after it passes through the Foramen Spinosum, but it can arise within or just below the Foramen Spinosum. The petrosal artery is commonly partially or completely hidden in the bone below the middle fossa floor. It most commonly reaches the facial nerve by passing through the bone enclosing the geniculate ganglion and tympanic segment of the nerve and less commonly by passing through the hiatus of the greater petrosal nerve. The petrosal artery frequently gives rise to a branch to the trigeminal nerve. The middle meningeal artery was absent in one of the 25 middle fossae, and a petrosal artery could not be identified in four middle fossae. The petrosal arteries were divided into three types based on their pattern of supply to the facial nerve. CONCLUSION The petrosal artery is at risk of being damaged during procedures in which the dura is elevated from the floor of the middle fossa, the middle fossa floor is drilled, or the middle meningeal artery is embolized or sacrificed. Several recommendations are offered to avoid damaging the facial nerve supply while performing such interventions.
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Blood supply of the facial nerve in the middle fossa: the petrosal artery.
Neurosurgery, 2008Co-Authors: Hatem El-khouly, Juan Fernandez-miranda, Albert L. RhotonAbstract:To define the arterial supply to the facial nerve that crosses the floor of the middle cranial fossa. Twenty-five middle fossae from adult cadaveric-injected specimens were examined under 3 to 40x magnification. The petrosal branch of the middle meningeal artery is the sole source of supply that crossed the floor of the middle fossa to irrigate the facial nerve. The petrosal artery usually arises from the first 10-mm segment of the middle meningeal artery after it passes through the Foramen Spinosum, but it can arise within or just below the Foramen Spinosum. The petrosal artery is commonly partially or completely hidden in the bone below the middle fossa floor. It most commonly reaches the facial nerve by passing through the bone enclosing the geniculate ganglion and tympanic segment of the nerve and less commonly by passing through the hiatus of the greater petrosal nerve. The petrosal artery frequently gives rise to a branch to the trigeminal nerve. The middle meningeal artery was absent in one of the 25 middle fossae, and a petrosal artery could not be identified in four middle fossae. The petrosal arteries were divided into three types based on their pattern of supply to the facial nerve. The petrosal artery is at risk of being damaged during procedures in which the dura is elevated from the floor of the middle fossa, the middle fossa floor is drilled, or the middle meningeal artery is embolized or sacrificed. Several recommendations are offered to avoid damaging the facial nerve supply while performing such interventions.
Samir E. Noujaim - One of the best experts on this subject based on the ideXlab platform.
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The persistent stapedial artery.
AJNR. American journal of neuroradiology, 2000Co-Authors: Richard Silbergleit, Douglas J. Quint, Bharat Mehta, Suresh C. Patel, Joseph J. Metes, Samir E. NoujaimAbstract:The persistent stapedial artery is a rare congenital vascular anomaly that may present as a pulsatile middle ear mass or that may appear as an incidental finding. Five cases of persistent stapedial artery are presented. The CT findings include the absence of the ipsilateral Foramen Spinosum and a soft-tissue prominence in the region of the tympanic segment of the facial nerve. Three cases were associated with an aberrant internal carotid artery. Imaging identification of this variant may obviate unnecessary surgery and may help in planning surgical or endovascular interventions.
C J Ukah - One of the best experts on this subject based on the ideXlab platform.
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a morphometric study of Foramen ovale and Foramen Spinosum of the human sphenoid bone in the southern nigerian population
Journal of Applied Biosciences, 2010Co-Authors: E A Osunwoke, C C Mbadugha, C N Orish, E L Oghenemavwe, C J UkahAbstract:Objective : Conduct a morphometric study of foramina ovale and Spinosum of the human sphenoid bone. Methodology and results : The study was carried out using 87 dry adult human skulls obtained from cadavers in the laboratories of the Departments of Anatomy of the Universities of Port Harcourt, Nnamdi Azikiwe University, Nnewi Campus, Okofia, University of Nigeria, Enugu Campus, Niger Delta University, Amassoma, Abia State University, Uturu and University of Calabar, all in Southern Nigeria. Measurements were done using a pair of dividers to span across the anteroposterior (length) and transverse (width) margins of the foramina and then transferred to a meter rule for the readings to be taken. The lengths of right and left Foramen ovale were 5.0 – 9.5mm and 5.0 – 9.0mm, respectively. The mean of the lengths of the right Foramen ovale was 7.01±0.10mm while that of the lengths of the left Foramen ovale was 6.89± 0.09mm. The widths of both right and left Foramen ovale were 2.0 - 5.0mm. The mean of the widths of the right Foramen ovale was 3.37± 0.07mm while that of the left Foramen ovale was 3.33±0.07mm. There was no significant difference between the mean of the length and width of the right and left Foramen ovale. The length of right and left Foramen Spinosum was 1.5 - 3.5mm and 1.0 - 4.0mm, respectively. The mean of the length of the right Foramen Spinosum was 2.34 ±0.05mm while that of the left was 2.36±0.05mm.The width of both right and left Foramen Spinosum was 1.0mm to 2.0mm. The mean of the widths of the right Foramen Spinosum was 1.66±0.03mm while that of the left Foramen Spinosum was 1.61±0.03mm. There was no significant difference between the mean of the length and width of the right and left Foramen Spinosum. Conclusion and application : This study is of clinical and anatomical significance to medical practitioners in cases of trigeminal neuralgia and in diagnostic detection of tumors and abnormal bony outgrowths.