Simple landmark for preservation of the cochlea during maximum drilling of the petrous apex through the anterior transpetrosal approach

Abstract

The cochlea is one of the most important organs to preserve during skull base surgery. However, no definite landmark for the cochlea has been identified during maximum drilling of the petrous apex such as anterior transpetrosal approach. The relationship between the cochlea and the petrous portion of the internal carotid artery (ICA) was assessed with computed tomography (CT) in 70 petrous bones of 35 patients, 16 males and 19 females aged 12-85 years (mean 48.6 years). After accumulation of volume data with multidetector CT, axial bone window images of 1-mm thickness were obtained to identify the cochlea and the horizontal petrous portion of the ICA. The distance was measured between the extended line of the posteromedial side of the horizontal petrous portion of the ICA and the basal turn of the cochlea. If the cochlea was located posteromedial to the ICA, the distance was expressed as a positive number, but if anterolateral, as a negative number. The mean distance was 0.6 mm (range -4.9 to 3.9 mm) and had no significant correlation with sex or age. The cochlea varies in location compared with the horizontal petrous portion of the ICA. Measurement of the depth and distance between the extended line of the posteromedial side of the horizontal intrapetrous ICA and the cochlea before surgery will save time, increase safety, and maximize bone evacuation during drilling of the petrous apex.