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Objectives/hypothesis Pathologic involvement of the inferior cochlear vein is a mechanism of sensorineural hearing loss in patients with jugular foramen paraganglioma. Study design Retrospective case-control study. Methods The presenting audiograms, magnetic resonance imaging, and computed tomography were reviewed in 46 subjects with jugular foramen paragangliomas. Four-frequency bone conduction average was compared between the tumor and nontumor ears in each subject to establish the presence of sensorineural hearing loss. Imaging findings for each subject were recorded. Univariate and multivariate statistical analyses were performed to determine which radiographic features were associated with sensorineural hearing loss. Hearing data were analyzed as a continuous variable and as a categorical variable. Results Twenty subjects (43.4%) had a bone-conduction pure-tone asymmetry of greater than 15 dB. Inferior cochlear vein involvement was identified in 19 of the 20 (95%) subjects with sensorineural hearing loss. Inferior cochlear vein involvement was found to be a statistically significant predictor of sensorineural hearing loss using univariate and multivariate analyses. Other imaging findings that were statistically significant predictors of sensorineural hearing loss include Glasscock-Jackson stage, Fisch-Mattox stage, hypoglossal canal involvement, jugulo-carotid spin erosion, and petrous carotid canal erosion. Conclusions Involvement of the inferior cochlear vein appears to be a plausible mechanism for sensorineural hearing loss in patients with jugular foramen paraganglioma. Level of evidence 4 Laryngoscope, 129:67-75, 2019.

The carotid canal must be taken into account during the surgical procedures since it contains the petrous segment of internal carotid artery. For this reason, we aimed to reveal the morphometric relationship of the carotid canal with related structures. The study was carried out with 11 parameters determined on a total of 52 sex unknown temporal bones belonging to the collection of Bursa Uludag University Faculty of Medicine, Anatomy Department. Measurements were taken by using mechanical sliding calipers and the findings were evaluated using the SPSS 22.0 program. Descriptive statistics of all variables were performed and correlation between the carotid canal and related structures were evaluated with the Spearman correlation analysis. Also, the correlation coefficient values were given. We developed the regression formulas to estimate the location of the carotid canal. There was a relationship between posterior and anterior point of external opening of carotid canal and mastoid process. The distance between the mastoid process-suprameatal spine and mastoid process-posterior root of zygomatic arch is highly correlated with each other.

Introduction The morphology of the skull base can be altered in craniosynostoses. The objective of this study is to evaluate the reduced intercarotid artery distance in the lacerum segment in patients with syndromic and isolated brachycephaly. Materials and Methods The distances between the inner walls of the carotid canal at the lacerum segment were measured on high-resolution CT scans in children with Crouzon (25), Pfeiffer (21), Apert (26), Saethre-Chotzen (7) syndromes, isolated bicoronal synostosis (9), and compared to an age-matched control group (30). Results A significantly smaller mean distance between carotid canal walls was observed in Crouzon (11.1 ± 4.9 mm), Pfeiffer (9.6 ± 5.1 mm), Apert (12.3 ± 4.3 mm), Saethre-Chotzen (14.8 ± 3.0 mm) syndromes, and isolated bicoronal synostosis (14.9 ± 3.7 mm) as compared to the control group (19.7 ± 2.4 mm, P P P P = 0.005, and P = 0.002, respectively). There was no statistically significant difference in intercarotid canal distance among the Apert, Saethre-Chotzen and isolated bicoronal synostosis groups. Overall, the brachycephalic group showed reduced intercarotid canal distance comparing to controls ( P Discussion and Conclusions There is significant reduction of the distance between carotid canals in brachycephalic patients. This distance is more significantly altered in FGFR -related brachycephaly syndromes (especially Crouzon and Pfeiffer syndromes), than Saethre-Chotzen syndrome ( TWIST1 mutation) and isolated non-syndromic bicoronal synostosis. This study highlights the importance of FGFR s in shaping the skull base. Altered vascular course of the internal carotid arteries can have important implications in planning skull base surgery in brachycephalic patients.

Goal: The aim of this work is to study the relationship between the pneumatization of the adjacent structures of sphenoid sinuses and the protrusion of the neurovascular structures in the sinuses. Methods: A review of 225 CT scans skull was done for subjects aged at least 16 years old from November 1st to December 31st 2017. The pneumatization of adjacent structures of sphenoid sinuses and its relation with the protrusion of neurovascular structures surround the sinuses have been investigated. We used Fischer Exact test for comparison. The p value < 0.05 was expressed as significant. Results: Statistically significant associations were found between anterior clinoid process bilateral pneumatization and bilateral protrusion of carotid canal (p < 0.05) and of optic canal (p < 0.001). There were also, statistically significant correlations between bilateral pterygoid process pneumatization and bilateral protrusion of carotid canal and of optic canal (p < 0.001); and between pterygoid process bilateral pneumatization and bilateral protrusion of maxillary and vidian nerves (p < 0.001). An association was also found between bilateral pneumatization of great wings and bilateral protrusion of maxillary nerves (p < 0.001) and of vidian nerves (p < 0.05). Conclusion: Compared to the literature, the prevalence of pneumatization of the adjacent structures of sphenoid sinuses was lower on Beninese than Caucasian and Asian. But there were the same correlations with the protrusion of neurovascular structures. In case of endonasal surgery of the sphenoid sinuses, surgeon should be aware of the high possibility the injury of optic nerves and internal carotid artery.

Background: Agenesis of the internal carotid artery (ICA) is a rare anatomic variation of the cerebral circulation. A malfunction during the embryonic peri-od is at stake. It is very often asymptomatic and therefore discovered inci-dentally. Association with ischemic stroke is exceptional. Physiopathology is uncertain; the hypothesis of a blood flow reversal is reported in the literature. The diagnosis is based on the absence of a carotid canal as revealed by CT scans at skull base level with bone settings. Other non-invasive techniques, in-cluding echo-Doppler of the neck vessels, can now make the diagnosis. Objec-tive: Discuss the association between occurrence of an ischemic stroke in the left posterior sylvian territory and discovery of ipsilateral carotid agenesis. Case report: A 24-year-old female patient was prospectively recruited at DAX hospital center (France). Vascular risk factors involved active smoking of 8 pack-years and a combined estrogen/progestin contraceptive. Her family history included an uncle with heterozygote Factor V Leiden mutation. She presented a left upper limb sensorimotor deficit. Nuclear Magnetic Resonance Angiography (MRA) revealed a right superficial sylvian ischemic stroke asso-ciated with agenesis of the right internal carotid artery. CT scan at skull base level with bone settings showed absence of a right carotid canal, thus confirm-ing agenesis. An opinion was then requested for an arteriography which showed an operative polygon of Willis, a sylvian artery or middle cerebral ar-tery (MCA) irrigated by a very large right posterior communicating artery (PCOM) and the left anterior cerebral artery (ACA) supplied by the anterior communicating artery (ACOM), through the left carotid system. The right syl-vian territory where stroke occurred was therefore supplied by the functional vertebrobasilar system. ECG and four-day meticulous monitoring detected no cardiac rhythm disorders. Transesophageal echocardiography was normal. Blood tests results showed normal blood coagulation with glycohemoglobin level at 4.6%. Total cholesterol was 1.42 g/l including LDL-C at 0.82 g/l and HDL-C at 0.36 g/l; triglycerides levels were 1.23 g/l. VDRL-TPHA serodiagnosis for syphilis, and HIV serology were all negative. Thrombophilia testing was performed and showed absence of Factor V Leiden mutation. Homocyste-inemia level was normal. The patient was discharged under KARDEGIC 160 mg, one daily with home rehabilitation. Currently she’s doing well and no re-currence is observed.

Rhabdomyosarcoma is a rare malignant tumour of striated muscle accounting for 3% of all primary soft tissue tumours of the middle ear cavity. We describe a unique case of a rhabdomyosarcoma of the middle ear cavity in a four-year-old boy, presenting as an otherwise asymptomatic ipsilateral Horner’s syndrome. This case involved tumour erosion through the tensor tympani semicanal, accessing the carotid canal and the sympathetic plexus running through it. This child was treated successfully with chemotherapy and proton beam therapy, and remains disease free at six years of follow-up. This case highlights the importance of investigating patients with non-resolving ear infections, polyps or granulation tissue.

Altres ajuts: CERCA Programme/Generalitat de Catalunya The small-bodied Miocene catarrhine Pliobates cataloniae (11.6 Ma, Spain) displays a mosaic of catarrhine symplesiomorphies and hominoid synapomorphies that hinders deciphering its phylogenetic relationships. Based on cladistic analyses, it has been interpreted as a stem hominoid or as a pliopithecoid. Intriguingly, the carotid canal orientation of Pliobates was originally described as hylobatid-like. The variation in carotid canal morphology among anthropoid clades shown in previous studies suggests that this structure might be phylogenetically informative. However, its potential for phylogenetic reconstruction among extinct catarrhines remains largely unexplored. Here we quantify the orientation, proportions, and course of the carotid canal in Pliobates, extant anthropoids and other Miocene catarrhines (Epipliopithecus, Victoriapithecus, and Ekembo) using three-dimensional morphometric techniques. We also compute phylogenetic signal and reconstruct the ancestral carotid canal course for main anthropoid clades. Our results reveal that carotid canal morphology embeds strong phylogenetic signal but mostly discriminates between platyrrhines and catarrhines, with an extensive overlap among extant catarrhine families. The analyzed extinct taxa display a quite similar carotid canal morphology more closely resembling that of extant catarrhines. Nevertheless, our results for Pliobates highlight some differences compared with the pliopithecid Epipliopithecus, which displays a somewhat more platyrrhine-like morphology. In contrast, Pliobates appears as derived toward the modern catarrhine condition as the stem cercopithecid Victoriapithecus and the stem hominoid Ekembo, which more closely resemble one another. Moreover, Pliobates appears somewhat derived toward the reconstructed ancestral hominoid morphotype, being more similar than other Miocene catarrhines to the condition of great apes and the hylobatid Symphalangus. Overall, our results rule out previously noted similarities in carotid canal morphology between Pliobates and hylobatids, but do not show particular similarities with pliopithecoids either-as opposed to extant and other extinct catarrhines. Additional analyses will be required to clarify the phylogenetic relationships of Pliobates, particularly given its dental similarities with dendropithecids.

A 38-year-old man presented to the emergency room in the trauma bay for multiple ballistic injuries to the right neck. He was hemodynamically stable, protecting his airway, and neurologically intact. Computed tomography angiography (CTA) revealed absent filling the right internal carotid artery from its origin to the circle of Willis, which was intact, as well as absent petrous carotid canal on the right. The patient was diagnosed with right internal carotid artery (ICA) agenesis and discharged in several days. This report demonstrates the importance of an in-depth knowledge of vascular embryology and anatomy. The patient has agreed to have images and case details published.

The vestibulocochlear organ is composed of tiny complex structures embedded in the petrous part of the temporal bone. Landmarks on the temporal bone surface provide the only orientation guide for dissection, but these need to be removed during the course of dissection, making it difficult to grasp the underlying three-dimensional structures, especially for beginners during gross anatomy classes. We report herein an attempt to produce a transparent three-dimensional-printed model of the human ear. En bloc samples of the temporal bone from donated cadavers were subjected to computed tomography (CT) scanning, and on the basis of the data, the surface temporal bone was reconstructed with transparent resin and the vestibulocochlear organ with white resin to create a 1:1.5 scale model. The carotid canal was stuffed with red cotton, and the sigmoid sinus and internal jugular vein were filled with blue clay. In the inner ear, the internal acoustic meatus, cochlea, and semicircular canals were well reconstructed in detail with white resin. The three-dimensional relationships of the semicircular canals, spiral turns of the cochlea, and internal acoustic meatus were well recognizable from every direction through the transparent surface resin. The anterior semicircular canal was obvious immediately beneath the arcuate eminence, and the topographical relationships of the vestibulocochlear organ and adjacent great vessels were easily discernible. We consider that this transparent temporal bone model will be a very useful aid for better understanding of the gross anatomy of the vestibulocochlear organ.

Background Agenesis of the internal carotid artery (ICA) is a rare vascular anomaly that was first observed postmortem. Various anastomoses supply the distal vessels at the site of agenesis. Of these anastomoses, an intercavernous anastomosis is very rare. This paper presents a patient with ischemic stroke in whom we discovered left ICA agenesis and an ipsilateral intercavernous anastomosis. Case A 58-year-old man with a history of myocardial infarction and diabetes mellitus presented with sudden-onset difficulty in speaking, numbness on the left side of the face, and weakness of the left arm and leg. Neurological examination revealed dysarthria, left facial paralysis, left hemiparesis, and bilateral absence of the plantar reflexes. Diffusion-weighted magnetic resonance imaging showed a right middle cerebral artery (MCA) infarction. On cranial and cervical magnetic resonance angiography, the left ICA could not be seen distal to the bifurcation; the left MCA was supplied through an intercavernous anastomosis between the right ICA and the left ICA. Cranial computed tomography (CT) revealed the absence of the left carotid canal. Digital subtraction angiography led to a diagnosis of left ICA agenesis with an intercavernous anastomosis. The patient was discharged on acetylsalicylic acid and warfarin. Conclusion ICA agenesis with an intercavernous anastomosis is a rare vascular anomaly that should be differentiated from secondary causes of ICA stenosis and occlusions by showing agenesis of the carotid canal on cranial CT.

The objective of this study is to illustrate prevention strategies and management of vascular complications from the jugular bulb (JB) and internal carotid artery (ICA) during middle ear surgery or cochlear implantation. The study design is retrospective case series. The setting is tertiary referral university hospital. Patients were included if presented pre- or intraoperative evidence of high-risk anatomical anomalies of ICA or JB during middle ear or cochlear implant surgery, intraoperative vascular injury, or revision surgery after the previous iatrogenic vascular lesions. The main outcome measures are surgical outcomes and complications rate. Ten subjects were identified: three underwent cochlear implant surgery and seven underwent middle ear surgery. Among the cochlear implant patients, two presented with anomalies of the JB impeding access to the cochlear lumen and one underwent revision surgery for incorrect positioning of the array in the carotid canal. Subtotal petrosectomy was performed in all cases. Anomalies of the JB were preoperatively identified in two patients with attic and external auditory canal cholesteatoma, respectively. In a patient, a high and dehiscent JB was found during myringoplasty, while another underwent revision surgery after iatrogenic injury of the JB. A dehiscent ICA complicated middle ear effusion in one case, while in another case, a carotid aneurysm determined a cholesterol granuloma. Rupture of a pseudoaneurysm of the ICA occurred in a child during second-stage surgery and required permanent balloon occlusion without neurological complications. Knowledge of normal anatomy and its variants and preoperative imaging are the basis for prevention of vascular complications during middle ear or cochlear implant surgery.

The purpose of this investigation was to evaluate the distances and angles on basal turn of cochlea in relation to round window at which the jugular bulb, internal carotid artery and facial nerve are at maximal risk and their implications in cochlear implantation (CI). Fifty-four cadaveric temporal bones were microdissected to expose the basal turn of cochlea, the carotid canal, the facial canal and the jugular fossa. The points were marked on the basal turn of cochlea, where there was minimum distance of basal turn of cochlea from the roof of the jugular fossa (point a), carotid canal (point b) and facial canal (point c). The distances and angles of these points from the round window were measured. The points a, b and c were at mean (range) distances of 2.8 mm (1.3–4.1 mm), 8.4 mm (6.5–10.4 mm) and 16.4 mm (12.5–20.5 mm) and at mean angles of 30° (15°–45°), 111° (71°–136°) and 284° (255°–315°), respectively, from the round window. This study highlights that 2.8 ± 0.5 mm (30 ± 5.40), 8.4 ± 1 mm (111 ± 12.70) and 16.4 ± 1.7 mm (284 ± 13.5) from the round window are the high-risk points on the basal turn of the cochlea for the jugular bulb, internal carotid artery and facial nerve, respectively. A wide range found for each parameter indicates that it is mandatory to evaluate these distances in each CI patient on preoperative radiographs to avoid intraoperative injury to these vital structures.

Background: The carotid canal (CC) located in the petrous temporal bone transmits the internal carotid artery, internal carotid venous plexus and sympathetic nerve plexus from the neck into the cranial cavity. It is an accessible passage into the cranial cavity and is considered an important anatomical landmark for neurosurgeons. The aim of this study was to investigate the topographical, morphometric and morphological parameters of the CC. Materials and methods: An examination of the CC and related adjacent structures in 81 dry skull specimens was performed. Distribution of sample by sex was 34 females and 47 males, and by race 77 African and 4 Caucasian. The mean age was 50 years (range: 14–100 years). Results: The external opening of the CC was found to be round-shaped, oval-shaped and tear-drop-shaped in 28.4%, 49.4% and 22.2% of the specimens, respectively. (1) Mean diameters [mm]: (a) medio-lateral 7.52 mm and (b) antero-posterior 5.41mm. Statistically significant difference in the vertical diameter was recorded in the race groups and laterality of the samples. (2) Mean distances [mm] between: (a) medial margins of external opening of CC was 50.03 mm, (b) lateral margins of external opening of CC was 62.73 mm and (c) external openings of CC and foramen lacerum was 15.6 mm. There was a statistically significant correlation between race and location of the opening of external CC in relation to foramen lacerum (viz. postero-lateral, lateral and diagonal, and lateral). Conclusions: The present study corroborated previous reports on the CC; however, the tear-drop shaped external CC opening was a unique finding. The knowledge of the reference measurements pertaining to the CC and its relationship to adjacent structures may postulate a suitable surgical “safe-zone” range within the CC area.

Congenital agenesis of the internal carotid artery is a very rare anomaly. Intracranial circulation in the involved internal carotid artery territory is maintained by collateral circulation from the contralateral internal carotid artery through the anterior communicating artery and from the vertebrobasilar system through the posterior communicating artery. Usually, patients with internal carotid artery agenesis are asymptomatic due to collateral circulation, but they may present with headache, seizures, or transient ischemic attack. Aneurysms have also been reported to be associated with this entity. Computed tomography angiography, magnetic resonance angiography, and digital subtraction angiography are commonly used modalities to make the diagnosis. Unenhanced skull base computed tomography will show the absence of carotid canal, thus differentiating from carotid hypoplasia. We report on a case of right internal carotid artery agenesis with discussion of embryogenesis, clinical presentation, and imaging findings.

Objective:This study aimed to examine the relationship of the accessory sphenoidal septum with surrounding vital structures and their variations.Methods:This cross-sectional retrospective study investigated the prevalence of accessory sphenoidal septa and their relationship with variations in surrounding vital structures in coronal and axial paranasal computed tomography images.Results:Coronal and axial computed tomography images of 347 patients were assessed to evaluate the presence of accessory sphenoidal septa. Accessory sphenoidal septa originated from the internal carotid artery in 47.7 per cent of patients and from the optic nerve in 17.5 per cent. These structures were significantly associated with protrusion of the optic nerve, internal carotid canal or Vidian nerve canal.Conclusion:Accessory sphenoidal septa can originate from the internal carotid artery or the optic nerve. Therefore, the presence of an accessory sphenoidal septum indicates an increased risk of surgical complications including internal carotid artery injury and loss of vision due to optic nerve injury.

A 41-year-old Korean man was admitted to our hospital with a 1-day history of headache and abnormal left visual field. Neurological examination revealed left homonymous hemianopia and difficulty in fine movement of the left finger. Laboratory studies indicated hyperlipidemia and hyperhomocysteinemia. Diffusion-weighted imaging showed a hyperintense signal on the right posterior cerebral-middle cerebral artery watershed area. Computed tomography angiography and carotid angiography revealed the bottle neck sign on the right internal carotid artery (ICA) with occlusion of the distal right ICA, but not the left ICA. Carotid angiography showed moyamoya vessels as well as occlusion of the distal right ICA. The right carotid canal was hypoplasic. We diagnosed the patient with unilateral moyamoya disease and carotid canal hypoplasia. This case demonstrates that unilateral carotid canal hypoplasia may co-exist with ipsilateral moyamoya disease. A unilateral bottle neck sign may indicate the presence of carotid canal hypoplasia. Evaluation of the bony carotid canal may be useful when it is necessary to distinguish between secondary vascular stenosis due to arteriosclerosis and MMD. Keywords: Moyamoya disease, Carotid canal, Bottle neck sign

A 28-year-old man without a significant medical history visited our hospital complaining of a headache. Computed tomography (CT) demonstrated thick, calcified vertebral artery (VA) and basilar artery (BA), despite the patient being young. Magnetic resonance angiography demonstrated the absence of the left internal carotid artery (ICA). The right ICA, the bilateral VA, and the BA were well developed and dolichoectatic. CT revealed the absence of the carotid canal on the left side. The condition was diagnosed as congenital agenesis of the left ICA with dolichoectatic changes in 3 other arteries. In a young patient with thick, calcified intracranial arteries, close examination is necessary, because vascular anomalies such as ICA agenesis may exist.

The infratemporal fossa (ITF) is bounded superiorly by the skull base, specifically the greater wing of the sphenoid, which contains foramen ovale. It is bordered posteriorly by the temporal bone, including the petrous portion of the carotid canal, anteriorly by the posterior wall of the maxillary sinus, laterally by the mandible, and medially by the pterygoid body and lateral pterygoid plate.1-3 In this video, we report a case of a rare, exclusively extradural, schwannoma originating from the third division of the trigeminal nerve with a widened foramen ovale at the skull base. The tumor filled the ITF and extended laterally just through the sigmoid notch of the mandible. The patient complained of left cheek and lower jaw numbness and intermittent left jaw spasms. The tumor was deemed appropriate for endoscopic resection. To access the ITF, left-sided endoscopic sinus surgery, a modified endoscopic Denker's approach,4 and posterior nasal septectomy were first performed. A nasoseptal flap was also harvested in case an intraoperative cerebrospinal fluid (CSF) leak required repair. Dissection was carried out through the posterior wall of the maxillary sinus and pterygopalatine fossa to reach the ITF. Tumor resection was achieved through a 2-surgeon, 4-handed approach in which appropriate traction and countertraction were carefully applied to tease the tumor away from the skull base and dehiscent carotid canal. No CSF leak or carotid injury occurred, and the posterior maxillary sinus wall defect was repaired with the nasoseptal flap. The patient did well postoperatively. The patient consented to the procedure in a standard fashion.

OBJECTIVES/HYPOTHESIS To identify which patients with temporal bone fractures who have already undergone trauma pan-scan computed tomography (CT) do not require an additional dedicated temporal bone CT. To determine the added cost of dedicated temporal bone CT in a lower-risk group of patients. STUDY DESIGN Retrospective chart review. METHODS A chart review was conducted of adult patients at a large level I trauma center with temporal bone fractures who underwent both trauma pan-scan CT and dedicated temporal bone CT. Patients were risk stratified into lower- and higher-risk groups based on imaging and physical exam findings. Imaging findings regarding five critical anatomic structures were compared between the two types of CT scans. RESULTS There were 180 patients who met inclusion criteria, with 120 patients stratified to the lower-risk group. The negative predictive values of trauma pan-scan CT within the lower-risk group for fracture involvement with the five critical anatomic structures were as follows: otic capsule (1.000), carotid canal (0.960), facial nerve canal (1.000), ossicular chain (0.992), and tegmen (0.856). The annual out-of-pocket cost to patients for dedicated temporal bone CT imaging in the lower-risk group was estimated to be approximately $34,000, for a total of $190,000 during the complete study period. CONCLUSIONS Trauma pan-scan CT may be sufficient in lower-risk patients to identify temporal bone fracture involvement with critical anatomic structures of the temporal bone. Reductions in dedicated temporal bone imaging will decrease both radiation exposure to trauma patients and strain on radiology departments. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E278-E282, 2021.

A 67-year-old woman was referred to the otolaryngology service after presenting to the emergency department for dizziness and loss of balance. She reported several similar episodes over the past years. Physical examination was unremarkable. A temporal bone CT scan revealed dehiscence between the bony carotid canal and the cochlea resulting in the diagnosis of carotid-cochlear dehiscence (CCD). CCD is an extremely rare condition involving the thinning of the bony canal separating the internal carotid artery from the cochlea. CCD is best diagnosed with temporal bone CT scan. Treatment options include observation as well as chemical or surgical labyrenthectomy. Despite similar clinical and diagnostic characteristics of reported CCD cases, general trends and consensus on treatment options cannot be ascertained due to the extreme rarity of this condition. Regardless of these limitations, CCD is a critical diagnosis as it mimics other inner ear conditions and poses a potential, significant surgical risk for the otolaryngologist.

Background: The styloid process (SP) refers to a cylindrical piece projecting from the inferior of the temporal bone, situated anterior to the stylomastoid foramen. It is an anatomic formation close to major vessels and nerves, and its excessive elongation results in pathologies leading to anatomical disorders, such as Eagle’s syndrome. Several studies have been conducted on SP in relation to its close proximity to vessels and nerves, but there is no study that reveals its distance to important anatomical formations, such as the internal auditory meatus (IAM), carotid canal (CC), cochlea, tegmen tympani (TT) and tragus. In the current study, we aimed to investigate the incidence of Eagle’s syndrome based on morphometric measurements of SP. Materials and methods: The patient files archived in the Radiology Department of Adiyaman University Training and Research Hospital were retrospectively examined. The study was carried out on the data of patients for whom specialist radiologists found no pathology findings on the computed tomography images. A total of 77 individuals (36 females and 41 males) aged 22 to 54 years were included in the study. The length of SP and its distances to IAM, cochlea, CC, TT and tragus were obtained using computed tomography radiological measurements. Results: When the individual measurements performed on computed tomography images were evaluated in men and women, no significant difference was found concerning the distance between SP and various anatomic structures in close proximity to SP (p > 0.05). However, there was a statistically significant difference between the genders in length of the right SP (p = 0.003) and left SP (p = 0.006). Conclusions: This anthropometric study revealed the standard morphometric measurements of SP. We believe that the data obtained will help clinicians to identify and diagnose pathologies more easily.

Objective To determine whether cranial metrics consistently differed between patients with moyamoya and age-, sex-, and race-matched controls. Methods Patients diagnosed with moyamoya disease by cerebral angiogram were obtained from a prospectively collected database through the Department of Neurosurgery at the University of Kansas Medical Center. Control patients matched by decade of age, sex, and race were collected through a deidentified hospital database by International Classification of Diseases-9 and 10 codes for ischemic stroke to identify patients with computed tomography angiograms. Imaging studies for both groups were analyzed to obtain 6 skull metrics: maximum anterior to posterior distance, maximum biparietal distance, bregma to occiput distance, right carotid canal diameter (CCD), left CCD, and cephalic index. Results Forty-five patients were identified in each cohort. Measurements of mean anterior to posterior skull diameter, mean biparietal skull diameter, bregma to occiput distances, and calculated cephalic index did not demonstrate a statistically significant difference between patients with moyamoya and control patients. Right carotid canal mean diameter was 4.8 mm for the moyamoya group and 5.4 mm for the control group, with a significant raw mean difference of −0.61 mm (95% confidence interval, −0.95 to −0.27). Left CCD was 4.7 mm for the moyamoya group and 5.5 mm for the control group, resulting in a significant raw mean difference of −0.76 mm (95% confidence interval, −1.09 to −0.43). Conclusions This study identified 2 skull parameters as statistically different in patients with moyamoya compared with a matched control group of patients with ischemic stroke: right CCD and left CCD.

To evaluate the incidence of vascular canal variations in the pediatric cochlear implant (CI) candidates.We retrospectively reviewed temporal bone computed tomography (CT) images of the CI candidates between November 2013 and November 2018. The presence of high riding jugular bulb, dehiscent jugular bulb, jugular bulb diverticulum, bulging of sigmoid sinus, mastoid emissary vein (MEV), carotid canal dehiscence, and aberrant internal carotid canal were evaluated. Findings were compared with a control group of normal-hearing subjects.Temporal CT images of 118 CI candidates and 119 control group participants were evaluated. The vascular canal anomalies were found in 88 (37.3%) temporal bones of the CI candidates and 49 (20.6%) of the control group (p 0.001). In 236 temporal CT scans of the CI candidates and 238 temporal CT scans of the control group, we found MEV in 19.1% and 6.3%, high riding jugular bulb in 11.4% and 10.5%, dehiscent jugular bulb in 2.1% and 1.3%, jugular bulb diverticulum in 6.4% and 1.7%, bulging sigmoid sinus in 11.4% and 4.2%, carotid canal dehiscence in 0.8% and 1.3%, and aberrant internal carotid canal in 0 and 0.8%, respectively. Jugular bulb diverticulum (p = 0.01), bulging of the sigmoid sinus (p = 0.003), and MEV (p 0.001) were more frequent in the CI candidates.Vascular canal variations are more common in the CI candidates and should be evaluated before CI surgery.

Objective A profound understanding of the relationship between the deep cervical fasciae and the skull base is essential for skull base surgery. To our knowledge, there has been little research on the relationship between the deep cervical fasciae and inferior surface of the skull base; thus, this study aims to examine the fascial network of the skull base. Methods Two cadaveric heads are dissected to reveal the fascial network of the skull base and 19 sides of cadaveric heads were used to reveal an anatomical variant of the pterygospinous and pterygoalar ligaments/muscles. Results The interpterygoid fascia is attached to the skull base along the sphenopetrosal fissure and tympanosquamous suture. The tensor vascular styloid fascia extends from the inferior border of the tensor veli palatini and covers the tympanic bone and styloid apparatus laterally. The pharyngobasilar fascia attaches to the pharyngeal tubercle on the inferior surface of the basilar part of the occipital bone and petro-occipital synchondrosis. In the middle of the clivus, we found thick fibrocartilaginous tissue and the prevertebral fascia fused to this area. Fascia of the longus capitis, the tensor-vascular styloid fascia, and stylopharyngeal fascia extend laterally and form the complex fascial network around the internal jugular vein and the internal carotid artery. The carotid sheath attaches anteriorly to the vaginal process and posteriorly to the fibrocartilaginous tissue around the jugular foramen and carotid canal. Conclusions This study comprehensively exposes the fascial network of the skull base. Our cadaveric dissection findings support those from previous imaging-anatomical studies. Precise knowledge of these fascial layers is essential for accurate diagnosis and understanding the spread of disease, as well as helping skull base surgeons safely perform challenging procedures.

Background: Vertebral artery (VA) to middle cerebral artery (MCA) bypass is a rarely selected technique because a complex expanded dissection is required, and often, a better donor artery than VA exists. A good indication for VA-MCA bypass is the treatment of head-and-neck malignancies with the sacrifice of the internal carotid artery (ICA) or for carotid artery rupture. Methods: A 23-year-old man with epipharyngeal carcinoma, treated by ligating the carotid artery with a VAMCA bypass before chemoradiotherapy, was reported. Radiographic findings showed that the bone of the carotid canal was dissolved, and the right ICA was engulfed by the tumor. As epipharyngeal carcinoma is hypersensitive to radiation, in cases where the tumor rapidly disappears, ICA may dangle in the pharynx and rupture may occur. In addition, to irradiate sufficiently, the ICA may become an obstacle. Hence, we decided to perform carotid ligation with a VA-MCA bypass before radiation and chemotherapy for the primary lesion. We selected the V3 portion of the VA as the donor on the ipsilateral side, as it can supply high-flow cerebral blood flow, which is not influenced by carcinoma and less influenced by irradiation for the epipharynx. Results: The VA-MCA bypass was completed without complications followed by endovascular occlusion of the ICA. Induction chemotherapy was initiated for the patient 2 weeks after surgery. The patient achieved a complete response following chemoradiotherapy. Conclusion: ICA ligation with VA-MCA high-flow bypass earlier than chemoradiotherapy is useful for epipharyngeal carcinoma as it prevents carotid artery rupture and allows radical intervention.