• Diego Méndez Rosito, Sheila Borrayo-Dorado, Elias Zorrilla-Madera, Javier F Sánchez-Gallardo, David Gallardo-Ceja, Francisco J Ríos, Yolanda Cárdenas, Paolo Palmisciano, Jonathan A Forbes, and Nadin J Abdala-Vargas.
• Laboratorio de Base de Cráneo, Centro Médico Nacional 20 de Noviembre, ISSSTE, Mexico City, Mexico. Electronic address: diegomendezrosito@gmail.com.
• World Neurosurg. 2024 Jan 1; 181: e67e74e67-e74.

BackgroundThe arcuate eminence (AE) is an anatomically consistent bony protrusion located on the upper surface of the petrous bone that has been previously studied as a reference for lateral skull base approaches. There is a paucity of information in the neurosurgical literature seeking to improve the safety of the extended middle cranial fossa (MCF) approach using detailed morphometric analysis of the AE.ObjectiveTo evaluate the use of the AE as an anatomical landmark to help with early identification of the internal acoustic canal (IAC) in MCF approaches by means of a cadaveric study, using a new morphometric reference termed the "M-point."MethodsA total of 40 dry temporal bones and 2 formalin-preserved, latex-injected cadaveric heads were used. The M-point was established as a new anatomic reference by identifying the intersection of a line perpendicular to the alignment of the petrous ridge (PR), originating from the midpoint of the AE, with the PR itself. Subsequent anatomical measurements were performed to measure the distance between M-point and IAC. Additional distances, including PR length and the anteroposterior and lateral AE surfaces, were also measured.ResultsThe mean distance between the M-point and the center of the IAC was 14.9 mm (SD ± 2.09), offering a safe drilling area during an MCF approach.ConclusionsThis study provides novel information on identification of a new anatomic reference point known as the M-point that that can be used to improve early surgical identification of the IAC.Copyright © 2023 Elsevier Inc. All rights reserved.

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