By Vinko V. Dolenc (auth.)
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Extra resources for Microsurgical Anatomy and Surgery of the Central Skull Base
29. The left leA in the petrous bone has been unroofed. The greater petrosal nerve (GPN) is adjacent to the lateral surface of the posterior loop (PL), slightly medial to the tensor tympani muscle (TTM) and the eustachian tube. The intact apex of the petrous bone (APB) medial to posterior loop (PL) lies within the posteromedial triangle, posterior to the Gasserian ganglion (GG) and nerve v. Venous drainage is medialward and posteriorly, into the SPS Fig. 30. The left petrous carotid canal has been unroofed, exposing the injected leA.
32. Dura over the inferomedial triangles has been removed bilaterally. On the right side, the injected parasellar space (PS) venous compartments have not been disturbed. The dorsal surface of the posterior clinoid process (PCP) is adjacent to "venous blood" in the superomedial corner of the right inferomedial triangle. In the left inferomedial triangle, however, some "venous blood" has been removed, exposing the petroclinoid ligament (PCL) and the posterior surface of the medial loop (ML) of the ICA antero-Iateral to it.
Posterior to V3 and lateral to the sphenopetrous fissure and the greater petrosal nerve (GPN), the thin layer of bone covering the petrous ICA has been removed. The lesser petrosal nerve and the tensor tympani muscle (TTM) lie dorsal and lateral to the petrous carotid canal. The posteromedial triangle is medial to the GPN, well posterior to the trigeminal nerve. A word of caution : Here the geniculate ganglion of nerve VII is not covered by bone. At live surgery: traction on the GPN or coagulation in the vicinity of the geniculate ganglion will result in peripheral facial palsy Fig.