Surgical anatomy of the internal auditory canal. A temporal bone dissection study.

The suboccipital fossa approach to the fundus of the internal auditory canal (IAC) at acoustic neurinoma surgery was investigated in 32 temporal bones. A microdissection was done under the operating microscope in a specially constructed holder so that the surgeon's exposure and angles of view through the craniotomy were mimicked. It was possible to obtain an unobstructed view of the transverse crest and the vestibular nerves in all specimens without the bony labyrinth being opened in the process. A prerequisite was that, as the posterior wall of the IAC was removed, drilling did not extend lateral to a line running through the midpoint of the craniotomy to the transverse crest. The distances of major structures from the posterior and superior pyramid surface were measured, using a special impression technique that made it possible to measure the thickness of the bony layer removed.