Magnetic resonance cisternography used to determine precise topography of the facial nerve and three components of the eighth cranial nerve in the internal auditory canal and cerebellopontine cistern

Abstract

Object. The detailed anatomy of intracranial structures has been studied mainly in cadavers, but the absence of cerebrospinal fluid and blood pressure in these models distorts normal spatial relationships. The authors investigated the rotation of the facial nerve (FN), superior vestibular nerve (SVN), inferior vestibular nerve (IVN), and cochlear nerve (CN) in the internal auditory canal (IAC) and cerebellopontine cistern in human volunteers and compared their results with those reported in cadaver studies.Methods. The IACs and cerebellopontine cisterns of 30 normal adults (34 sides) were examined using magnetic resonance (MR) cisternography with a heavily T2-weighted two-dimensional fast spin—echo technique. The positions of the four components were unaffected by the presence of the meatal loop of the anterior inferior cerebellar artery in the IAC. The spatial relationship between the FN and SVN was quite constant, but the spatial relationship between the CN and SVN was quite variable: the former changed position, mainly in the IAC, on nine (26.5%) of 34 sides, and in the cerebellopontine cistern on the other sides (73.5%), conflicting with findings in cadaver studies.Conclusions. It is more accurate to describe the CN and IVN as coursing beneath the SVN in either the IAC or cerebellopontine cistern, rather than stating that the three components rotate, as reported in cadaver studies. The MR cisternography studies provided quite detailed information about the topography of the four components and the relationship between the blood vessels and cranial nerves in the IAC and the cerebellopontine cistern.