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152. Describe the surgical anatomy of the cerebellopontine angle under the
following:
a. Boundaries, relations and contents
Boundaries
superior: tentorium cerebelli
posterior: anterior surface of cerebellum
inferior: lower cranial nerves
anterior: prepontine cistern
anterolateral: posterior surface of petrous temporal bone, including internal
acoustic meatus
medial: pons
Relations
CN V lies superior to this space
CN IX, CN X, and CN XI lie inferior
the middle cerebellar peduncle is inferior
Contents
CN VII
CN VIII
flocculus of the cerebellum
foramen Luschka of the 4th ventricle
anterior inferior cerebellar artery (AICA)
Related pathology
cerebellopontine angle masses
o acoustic schwannomas (nearly 80% of all CP angle tumours)
o meningiomas
o epidermoid cysts
o dermoid tumours
o arachnoid cysts
o lipomas
o metastatic tumours
o vascular tumours
petrous apicitis
abducens nerve palsy, secondary to involvement of the nerve as it passes
through Dorello canal
retro-orbital pain, or pain in the cutaneous distribution of the frontal and maxillary
divisions of the trigeminal nerve, due to extension of inflammation into Meckel
cave
Common pathogens are Pseudomonas and Enterococcus spp.
Translabyrinthine Approach
The microsurgical translabyrinthine approach was described by House in 1964. It
exposes the posterior fossa dura in the retromeatal trigone (Trautmann's triangle)
formed by the sigmoid sinus, the jugular bulb and the superior petrosal sinus. This
approach is usually reserved for patients with moderate-size tumors (1.0 to 2.5 cm in
diameter).
Translabyrinthine-transtentorial Approach
Subtemporal-Transtentorial Approach