Use of reconstructed sagittal computed tomography images to plan middle cranial fossa surgery

Objective: To facilitate planning in temporal bone surgery for the middle c ranial fossa approach by using sagittal reconstructed temporal bone compute d tomography images. Study Design: Comparison of anatomic measurements on r andom high-resolution, reformatted computed tomography scans of the tempora l bone. Methods. High-resolution computed tomography of 10 normal temporal bones in the axial and coronal planes was obtained, and two-dimensional sag ittal reconstructions were performed using a commercial software program. E ight anatomical relationships between neural and/or vascular structures wer e measured. Representative images were inverted to recreate the plane of th e middle cranial fossa approach. Results. Anatomical relationships among th e vestibule, superior semicircular canal, internal auditory canal, internal carotid artery, and middle cranial fossa exhibited a high SD in the 10 sub jects. The sample size and the large range for the eight anatomical relatio nships precluded the detection of a significant difference between right an d left temporal bones or sex and age of the patient. Conclusion: The presen t report presents a novel, practical measurement protocol for rapidly evalu ating important individual anatomical differences in patients before middle cranial fossa surgery. Inverted sagittal reconstructions facilitate presur gical planning for the middle cranial fossa approach by 1) assessing critic al anatomical relationships before surgery and 2) providing customized meas urements between vital landmarks and the first in vivo measurements. This d ecreases the likelihood of surgical mishaps and improves teaching by provid ing the first in vivo measurements of practical anatomical relationships in the sagittal plane.