INTRODUCTION

ANATOMY AND SURGICAL APPROACHES OF THE

TEMPORAL BONE AND ADJACENT AREAS
Neurosurgery 61:S4-1, 2007

DOI: 10.1227/01.NEU.0000280027.92382.2B

he temporal bone is the most complicated osseous structure in the human body. Five parts participate in its formation. The facial and carotid canals in the temporal bone
are the longest canals of passage of any cranial nerve or artery
through the cranium. This complexity is further increased by
the genus, and bends in the facial nerve and carotid artery
within the temporal bone. The presence of the delicate cochlear
and vestibular membranes within the temporal bone makes it
the only bone that houses the end organs of a cranial nerve. It
also houses the complicated mechanism for transmitting
sounds from the outward world to the inner ear. The fact that
the temporal bone faces the middle and posterior cranial fossa
and also has lateral and lower surfaces yields the potential for
multiple complex surgical routes to the temporal bone, and
through it to deeper areas. It is the focus of more surgical routes
and approaches than any other bone in the cranium. The delicate neural, vascular, and transmission systems within the bone
add to the complexity of these surgical approaches and provide
a special challenge in dealing with lesions in the area. This
work, done with many of our research fellows, represents
knowledge gained from nearly five decades of the study of
microsurgical anatomy. We hope that the illustrations in three
dimensions will aid all who deal with this complicated and
delicate anatomy.
Our previous article (Chapter 1) on the temporal bone was
included as a starting point because it provides an up-to-date
two-dimensional description of the anatomy and approaches
to the temporal bone (1). Additional information on the surrounding area will be found in the volume Cranial Anatomy and
Operative Approaches published by NEUROSURGERY (2). The
three-dimensional (3D) part begins with a review of the osseous
relationships and proceeds through the anatomy and surgical
approaches directed to and through the temporal bone from
the middle and posterior fossa and laterally through the mastoid. This is followed by sections related to the exposures
directed along the margins of the temporal bone, which include
the far lateral and transcondylar approaches and the approaches
to the jugular foramen and fourth ventricle. Each of the latter
sections is preceded by a short description of the approach.
The pages with the 3D illustrations are to be viewed with the
colored glasses. On the lower right, below the large 3D illustration, is a two-dimensional illustration with labels guiding the
viewer to the important structures in the area. Each illustration
is followed by a short legend. The 3D illustrations are to be
viewed with the blue lens of the colored glasses placed in front

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of the right eye and the red lens in front of the left eye. Some of
the cardboard glasses can be bent so the red and blue are
reversed with a resulting loss of 3D viewing.
This volume is dedicated to the fellows who have labored in
our microsurgery laboratory beginning more than 40 years ago.
Each fellow has been challenged to improve and build upon
the efforts of the previous fellow. Several dozen fellows, beginning with Shigeaki Kobayashi in 1966, have made contributions to our knowledge of the temporal bone and surrounding
areas. Special thanks go to Robin Barry, who has worked with
us for more than two decades and who aligned all the pictures
for 3D images, and to Laura Dickinson, who has labored over
this manuscript.
Capturing 3D images of the quality presented here requires
careful preparation of the specimen and meticulous dissection,
followed by the even greater challenge of obtaining satisfactory
3D images. Obtaining excellent specimens, completing meticulous specimen preparation, and combining that with surgically
precise dissections, and outstanding two- and 3D photography
is a rare achievement. We hope this work will enhance the
readers understanding of this complex area and that it will
result in accurate, gentle, and safe operative procedures for
patients requiring surgery in this delicate area.
This work is dedicated to the microsurgery fellows at the
University of Florida who, for more than 40 years, have taught
me so much about microsurgical anatomy and the temporal bone.
Hiroshi Abe, Japan
Hajime Arai, Japan
Allen S. Boyd, Jr., Tennessee
Robert Buza, Oregon
Alvaro Campero, Argentina
Alberto C. Cardoso, Brazil
Christopher C. Carver, California
Patrick Chaynes, France
Chanyoung Choi, Korea
Evandro de Oliveira, Brazil
Hatem El Khouly, Egypt
W. Frank Emmons, Washington
J. Paul Ferguson, Georgia
Juan C. Fernandez-Miranda, Spain
Andrew D. Fine, Florida
Brandon Fradd, Florida
Kiyotaka Fujii, Japan
Yutaka Fukushima, Japan
Adriano Garcia-Scaff, Brazil

VOLUME 61 | NUMBER 4 | OCTOBER 2007 SUPPLEMENT 4 | S4-1

RHOTON

Hirohiko Gibo, Japan

John L. Grant, Virginia
Kristinn Gudmundsson, Iceland
David G. Hardy, England
Frank S. Harris, Texas
Tsutomu Hitotsumatsu, Japan
Takuya Inoue, Japan
Tooru Inoue, Japan
Yukinari Kakizawa, Japan
Toshiro Katsuta, Japan
Masatou Kawashima, Japan
Chang Jin Kim, South Korea
Robert S. Knego, Florida
Shigeaki Kobayashi, Japan
Chae Heuck Lee, South Korea
Xiao-Yong Li, China
William Lineaweaver, California
J. Richard Lister, Florida
Qing Liang Liu, China
Jack E. Maniscalco, Florida
Richard G. Martin, Alabama
Carolina Martins, Brazil
Haruo Matsuno, Japan
Toshio Matsushima, Japan
J. Robert Mozingo, deceased
Hiroshi Muratani, Japan
Antonio C.M. Mussi, Brazil
Shinji Nagata, Japan
Yoshihiro Natori, Japan
Kazunari Oka, Japan
Michio Ono, Japan

Shigeyuki Osawa, Japan

T. Glenn Pait, Arkansas
Wayne S. Paullus, Texas
David Perlmutter, Florida
Mark Renfro, Texas
Wade H. Renn, Georgia
Saran S. Rosner, New York
Pablo Rubino, Argentina
Naokatsu Saeki, Japan
Shuji Sakata, Japan
Eduardo R. Seoane, Argentina
Xiang-en Shi, China
Satoru Shimizu, Japan
Ryusui Tanaka, Japan
Necmettin Tanriover, Turkey
Helder Tedeschi, Brazil
Erdener Timurkaynak, Turkey
Xiaoguang Tong, China
Satoshi Tsutsumi, Japan
Jay Ulm, Florida
Hung T. Wen, Brazil
C.J. Whang, South Korea
Isao Yamamoto, Japan
Alexandre Yasuda, Brazil
Nobutaka Yoshioka, Japan
Arnold A. Zeal, Florida
1. Rhoton AL Jr: The temporal bone and transtemporal approaches.
Neurosurgery 47 [Suppl 3]:S211S265, 2000.
2. Rhoton AL Jr: Cranial Anatomy and Surgical Approaches. Baltimore,
Lippincott Williams & Wilkins, 2003.

From Pernkopf E, Ferner H: Atlas of Topographical and Applied Human Anatomy. Philadelphia, W.B. Saunders Company, 1963.