Abstract
A thorough knowledge of the gross and micro‐anatomy of the human internal acoustic canal (IAC) is essential in vestibular schwannoma removal, cochlear implantation (CI) surgery, vestibular nerve section, and decompression procedures. Here, we analyzed the acoustic‐facial cistern of the human IAC, including nerves and anastomoses using synchrotron phase contrast imaging (SR‐PCI). A total of 26 fresh human temporal bones underwent SR‐PCI. Data were processed using volume‐rendering software to create three‐dimensional (3D) reconstructions allowing soft tissue analyses, orthogonal sectioning, and cropping. A scalar opacity mapping tool was used to enhance tissue surface borders, and anatomical structures were color‐labeled for improved 3D comprehension of the soft tissues. SR‐PCI reproduced, for the first time, the variable 3D anatomy of the human IAC, including cranial nerve complexes, anastomoses, and arachnoid membrane invagination (acoustic‐facial cistern; an extension of the cerebellopontine cistern) in unprocessed, un‐decalcified specimens. An unrecognized system of arachnoid pillars and trabeculae was found to extend between the arachnoid and cranial nerves. We confirmed earlier findings that intra‐meatal vestibular schwannoma may grow unseparated from adjacent nerves without duplication of the arachnoid layers. The arachnoid pillars may support and stabilize cranial nerves in the IAC and could also play a role in local fluid hydrodynamics.
Highlights
Vestibular nerve schwannoma removal and cochlear implantation (CI), as well as other surgical interventionsXueshuang Mei and Nadine Schart-Moren contributed to this work.Accepted for publication 16 November 2018 Article published online 18 December 2018 such as facial nerve (FN) decompression and vestibular nerve section, require a detailed comprehension of the complex anatomy of the internal acoustic canal (IAC)
Dissections of the temporal bone occasionally injured the soft tissue in the IAC
The 3D imaging allowed visualization of the cochleo-vestibulo-facial nerve complex but not the vestibular ganglia located in the nerves
Summary
Accepted for publication 16 November 2018 Article published online 18 December 2018 such as facial nerve (FN) decompression and vestibular nerve section, require a detailed comprehension of the complex anatomy of the internal acoustic canal (IAC). There has been debate about the extension and relationship of the cranial nerves to the acoustic-facial cistern, which is relevant to vestibular schwannoma surgery (Yasargil et al 1977; Lescanne et al 2002). The intricate nerve anatomy with numerous connections in the IAC was studied by several investigators in early anatomic works, using different techniques and species (Retzius, 1881; Streeter, 1906; Voit, 1907; Oort, 1918; de No, 1926; Hardy, 1934; Paturet, 1951; Shute, 1951; Gacek & Rasmussen, 1961). Mei et al 317 clinically oriented investigations (House, 1961; Rhoton et al 1968; Fisch, 1973; Chouard, 1975; Silverstein, 1984; Silverstein et al 1988; Ryu et al 1999; Agirdir et al 2001; Kos et al 2006) including micro-dissections (Bergstrom, 1973), descriptions of meningeal layers (Lescanne et al 2002), magnetic resonance imaging (MRI; Rubinstein et al 1996; Unel et al 2012), and electron microscopy combined with cadaveric anatomy (Arnesen, 1984; Ozdogmus et al 2004)
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