• Mamdouh Tawfik-Helika, Patrick Mertens, Guilherme Ribas, Michael D Cusimano, Martin Catala, Ramez Kirollos, and Timothée Jacquesson.
• Department of Neurosurgery, Beaujon University Hospital, Assistance publique hopitaux de Paris, Clichy, France. Electronic address: drmamdoh@hotmail.com.
• World Neurosurg. 2019 Apr 1; 124: e65e80e65-e80.

BackgroundLearning surgical anatomy of the petrous pyramid can be a challenge, especially in the beginning of the training process. Providing an easier, holistic approach can be of help to everyone with interest in learning and teaching skull base anatomy. We present the complex organization of petrous pyramid anatomy using a new compartmental approach that is simple to understand and remember.MethodsThe surfaces of the petrous pyramid of two temporal bones were examined; and the contents of the petrous pyramid of 8 temporal bones were exposed through progressive drilling of the superior surface.ResultsThe petrous pyramid is made up of a bony container, and its contents were grouped into 4 compartments (mucosal, cutaneous, neural, and vascular). Two reference lines were identified (mucosal and external-internal auditory canal lines) intersecting at the level of the middle ear. The localization of contents relative to these reference lines was then described, and 2 methods of segmentation (the X method and the V method) were then proposed. This description was then used to describe middle ear relationships, facial nerve anatomy, and air cell distribution.ConclusionsThis new compartmental approach allows a comprehensive understanding of the distribution of petrous pyramid contents. Dividing it into anatomic compartments, and then navigating this mental map along specific reference points, lines, spaces, and segments, could create a useful tool to teach or learn its complex tridimensional anatomy.Copyright © 2019 Elsevier Inc. All rights reserved.

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