The aim of this study was to investigate the relationships/variations between the facial nerve hiatus (FNH) and middle cranial fossa neuro-vascular structures. Twenty CT-scanned middle cranial fossae of fresh adult cadavers were used; the greater superficial petrosal nerves, and critical neuro-vascular structures were identified. Using the FNH as a reference point, a neuronavigation system was used to measure the distance between each structure and the FNH. The coefficient of variation (CV) was used to quantify the degree of variation among each distance. The mean distances and standard deviations between the various landmarks and the FNH, and the associated CV were analyzed. Furthermore, a microanatomical map of the structures hidden in the middle fossa based on the greater superficial petrosal nerve was generated. The most reliable relationships of the FNH were with the internal auditory canal (CV = 14.59), and with the vertical portion of the intrapetrous internal carotid artery (CV = 15.54). Our data demonstrate that the FNH can be used as anatomical landmark to plot the position of several hidden neurovascular structures when performing a middle-fossa skull base approach. However, the pattern and the variation of these structures had to be recognized.
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