Chapter 14 - Anatomy of petrous face

Abstract

The anatomy of the petrous face of the temporal bone, also known as the petrous pyramid, should be carefully examined to understand the location of, blood supply to, and venous drainage of meningiomas in this area (42%-59% of posterior fossa meningiomas). The petrous face is located in the skull base between the sphenoid and occipital bones. It consists of a base that joins the mastoid laterally and an apex that extends anteromedially to form the foramen lacerum. The anatomy can be divided into three surfaces: anterior/superior, posterior, and inferior. The anterior/superior surface is a continuation of the posteromedial portion of the middle cranial fossa with boundaries extending from the arcuate eminence to the petrous apex. The posterior surface is a continuation of the front part of the posterior cranial fossa with the internal auditory meatus at its center. The inferior surface contains foramina that transmit important vessels and cranial nerves. The vascular anatomy of the petrous face is also described, including branches of the carotid artery and vertebrobasilar systems. It is imperative to understand potential anastomotic routes between extracranial and intracranial arteries, as well as arterial supply to cranial nerves, to facilitate preoperative transarterial embolization of meningiomas and avoid neurologic complications during surgery.