The petrous carotid artery: anatomic relationships in skull base surgery

Advanced transcranial lesions may be successfully resected through a variety of contemporary skull base approaches. The identification and isolation of the internal carotid artery throughout its petrous course is essential in most of these surgical techniques. Anatomic landmarks normally used to identify this vital structure, however, may be severely distorted by tumor involvement or previous operative dissection. In an effort to define surgical landmarks that may be used in the identification of the petrous carotid artery, histologic sections of 100 temporal bones from adults were examined and microscopic measurements were recorded from the anatomic dissection of 10 fresh cadaver halfheads. On the basis of these studies, structures we have found useful in identification of the vertical petrous carotid artery during lateral skull base approaches include the: base of the styloid process, bony vascular crest, basal turn of the cochlea, medial wall of the eustachian tube, and the cochleariform process. Identification of the horizontal segment can be achieved by the preliminary delineation of the middle meningeal artery, greater petrosal nerve, tensor tympani muscle, mandibular and maxillary divisions of the trigeminal nerve, and the eustachian tube. Specific anatomic relationships with associated measurements are detailed and correlated with selected, illustrative cases.