Anatomy of the para-vestibular canaliculus

A histologic study of the para-vestibular canaliculus (PVC), its contents, and its relationship to the vestibular aqueduct (VA), is presented. 20 normal human temporal bones were fixed in 10% formalin solution, embedded in celloidin, and sectioned horizontally at intervals of 20 micrometers. Every tenth section was stained with hematoxylin and eosin (HE) and studied under a light microscope. Three significant observations were made. First, in 80% of the specimens, two rather than one PVC were found in the area of the vestibular orifice of the VA. Second, in 70% of the specimens, the PVC was found to merge with the VA rather than to enter the posterior cranial fossa (PCF) separately. Third, in all the specimens examined, a vein was seen to traverse the entire length of the PVC. However, in 17 specimens, no artery could be identified within the PVC. In the 13 (65%) specimens in which arteries could be identified in the PVC, the arteries extended only half the length of the PVC, from the PCF to the VA. In no specimen examined could arteries be seen extending the full length of the PVC from the PCF to the vestibule.

The intravestibular source of the vestibular aqueduct. II: its structure and function clarified by a developmental study of the intra-skeletal channels of the otic capsule

CONCLUSION

A developmental histologic study of the otic capsule indicates that it grows a system of lamellar bone with abundant interconnecting intraosseous channels. These include the 'cartilage canals' in the cartilage model, the chondro-osseous and Haversian-like (Volkmann's) canals in the ossified otic capsule, the fissula ante fenestram, which seems to function as a lifelong manufacturer of the latter two channels, and the inner layer (vestibular arch) of the vestibular aqueduct, which is a complex series of Volkmann's canals and microcanals. Chemical changes, possibly produced by breakdown of cells within the channels, may provide a homeostatic environment for the functions of hearing and balance that take place in the endolymphatic fluid.

OBJECTIVES

We studied the development of the otic capsule to clarify the cellular appearances that we had previously described in the normal vestibular arch and the changes in that structure in Ménière's disease.

METHODS

Step sections from 84 temporal bones, including those from fetuses, children and adults from a variety of ages were examined histologically.

RESULTS

Cartilage canals, bringing blood vessels and mesenchymal cells from perichondrium to the depths of the cartilage model to mediate ossification, are found early in fetal life and disappear when ossification is complete at about 24 weeks. The otic capsule is formed of chondro-osseous canals, which are composed of trabeculae of mineralized cartilage lacunae containing mesenchymal cells that undergo ossification (globuli ossei); also Volkmann's canals (like Haversian canals in long bones but multidirectional), which are produced from osteoblasts. The lumina of the latter frequently link up with chondro-osseous canals. Lamellar bone forms the background of the otic capsule. The fissula ante fenestram is present from early in the cartilage model and then throughout life. It appears to mediate bone production and the new formation of chondro-osseous channels and Volkmann's canals. The internal layer of the vestibular aqueduct (vestibular arch) is seen in the cartilage model of the otic capsule (present in early fetal life) as a vascular layer of perichondrally derived connective tissue (not cartilage) surrounding the endolymphatic duct. When endochondral ossification starts, the bone from the adjoining cochlear and vestibular sides embrace this connective tissue layer to form the outer bony layer of the vestibular aqueduct. Osteoblasts then fill the inner layer with lamellar bone and macro- and mini-Volkmann's canals. At 1 year osteoblasts in the walls of macro-Volkmann's canals, proliferating thereafter throughout life, produce large numbers of microcanals. It is possible that slow breakdown of these osteoblasts and of similar cells in the canals of the otic capsule proper may contribute to the homeostasis of the endolymphatic duct and that of the rest of the membranous labyrinth, respectively.

Clinical investigation and mechanism of air-bone gaps in large vestibular aqueduct syndrome

OBJECTIVES

Patients with large vestibular aqueduct syndrome (LVAS) often demonstrate an air-bone gap at the low frequencies on audiometric testing. The mechanism causing such a gap has not been well elucidated. We investigated middle ear sound transmission in patients with LVAS, and present a hypothesis to explain the air-bone gap.

METHODS

Observations were made on 8 ears from 5 individuals with LVAS. The diagnosis of LVAS was made by computed tomography in all cases. Investigations included standard audiometry and measurements of umbo velocity by laser Doppler vibrometry (LDV) in all cases, as well as tympanometry, acoustic reflex testing, vestibular evoked myogenic potential (VEMP) testing, distortion product otoacoustic emission (DPOAE) testing, and middle ear exploration in some ears.

RESULTS

One ear with LVAS had anacusis. The other 7 ears demonstrated air-bone gaps at the low frequencies, with mean gaps of 51 dB at 250 Hz, 31 dB at 500 Hz, and 12 dB at 1,000 Hz. In these 7 ears with air-bone gaps, LDV showed the umbo velocity to be normal or high normal in all 7; tympanometry was normal in all 6 ears tested; acoustic reflexes were present in 3 of the 4 ears tested; VEMP responses were present in all 3 ears tested; DPOAEs were present in 1 of the 2 ears tested, and exploratory tympanotomy in 1 case showed a normal middle ear. The above data suggest that an air-bone gap in LVAS is not due to disease in the middle ear. The data are consistent with the hypothesis that a large vestibular aqueduct introduces a third mobile window into the inner ear, which can produce an air-bone gap by 1) shunting air-conducted sound away from the cochlea, thus elevating air conduction thresholds, and 2) increasing the difference in impedance between the scala vestibuli side and the scala tympani side of the cochlear partition during bone conduction testing, thus improving thresholds for bone-conducted sound.

CONCLUSIONS

We conclude that LVAS can present with an air-bone gap that can mimic middle ear disease. Diagnostic testing using acoustic reflexes, VEMPs, DPOAEs, and LDV can help to identify a non-middle ear source for such a gap, thereby avoiding negative middle ear exploration. A large vestibular aqueduct may act as a third mobile window in the inner ear, resulting in an air-bone gap at low frequencies.

When is the vestibular aqueduct enlarged? A statistical analysis of the normative distribution of vestibular aqueduct size

BACKGROUND AND PURPOSE

The size of vestibular aqueducts (VAs) seen on CT studies varies. The current practice of calling a VA enlarged when it exceeds a certain threshold (eg, 1.5 mm at the midpoint) is arbitrary. Our hypothesis was that statistical analysis of the range of VA widths in a normal-hearing population would lead to a mathematic definition of the upper-limit-of-normal VA width.

MATERIALS AND METHODS

The VA midpoint and opercular widths were measured in 73 children with normal hearing. Statistical analysis yielded values of the 99 th, 97.5th, 95th, 90th, 75th, and 50th percentiles for this normal distribution.

RESULTS

The upper-limit-of-normal (95th percentile) values for the VA midpoint and opercular widths were 0.9 and 1.9 mm, respectively. The VAs with greater widths may reasonably be considered enlarged.

CONCLUSION

The VAs with midpoint or opercular widths of 1.0 and 2.0 mm or greater, respectively, are enlarged.

Three-Dimensional Morphology of the Vestibular Cleft and Its Potential Application

HYPOTHESIS

To delineate quantitatively the spatial relationships of the utricle, saccule, and stapedial footplate, to locate the hole on the footplate, and to analyze the insertion depth into the vestibule and the direction of the piston during stapedotomy.

BACKGROUND

The quantitative three-dimensional (3D) configuration of the utricle, saccule, and stapedial footplate is undetermined, and the stapedotomy procedures should be improved.

METHODS

Four temporal bones were extracted from the fresh cadavers and were undecalcified polymer-embedded. The specimens were sectioned into serial 50-mum-thickness slices. After image processing and 3D reconstruction, a cartesian coordinate system was established to display the spatial relationships of the utricle, saccule, and stapedial footplate in the 3D Studio Max scene. The configuration of the utricle, the saccule, and the "vestibular cleft" was delineated quantitatively with the contour map method. With this contour map, any distance between one point at the surface of the footplate and another point at the surface of the utricle or saccule and its orientation can be measured.

RESULTS

There was a V-shaped cleft between the utricle and the saccule named vestibular cleft. The angle of the cleft was 50.30 degrees +/- 19.90 degrees . The apex of the cleft always directed anterosuperiorly, whereas beneath the posteroinferior part of the footplate was an open and deep "seabed." The vertical distances between points on the tympanic surface of the footplate and points on the surface of the utricle or saccule were measured. The vertical distance from the center point of footplate to the vestibular end organs was 2.20 +/- 0.548 mm, the maximum distance being 3.0 mm, whereas the minimum distance was 1.6 mm.

CONCLUSION

The posteroinferior area near the central point of the footplate is the optimal position for the fenestra through which the piston can be inserted relatively safely into a depth of 0.8 to 1.0 mm in the vestibule. If the deep end of the piston is inclined inferiorly and posteriorly by 8 to 10 degrees, respectively, the piston will be farther from the vestibular end organs. These manipulations may enhance surgical safety and efficiency in stapedotomy.

Morphological analysis of the vestibular aqueduct by computerized tomography images

OBJECTIVE

In the last two decades, advances in the computerized tomography (CT) field revise the internal and medium ear evaluation. Therefore, the aim of this study is to analyze the morphology and morphometric aspects of the vestibular aqueduct on the basis of computerized tomography images (CTI).

MATERIAL AND METHOD

Computerized tomography images of vestibular aqueducts were acquired from patients (n=110) with an age range of 1-92 years. Thereafter, from the vestibular aqueducts images a morphometric analysis was performed. Through a computerized image processing system, the vestibular aqueduct measurements comprised of its area, external opening, length and the distance from the vestibular aqueduct to the internal acoustic meatus.

RESULTS

The morphology of the vestibular aqueduct may be funnel-shaped, filiform or tubular and the respective proportions were found to be at 44%, 33% and 22% in children and 21.7%, 53.3% and 25% in adults. The morphometric data showed to be of 4.86 mm(2) of area, 2.24 mm of the external opening, 4.73 mm of length and 11.88 mm of the distance from the vestibular aqueduct to the internal acoustic meatus, in children, and in adults it was of 4.93 mm(2), 2.09 mm, 4.44 mm, and 11.35 mm, respectively.

CONCLUSIONS

Computerized tomography showed that the vestibular aqueduct presents high morphological variability. The morphometric analysis showed that the differences found between groups of children and adults or between groups of both genders were not statistically significant.

Estimation of the endolymphatic sac and vestibular aqueduct using magnetic resonance imaging

OBJECTIVE

To evaluate the diagnostic accuracy of magnetic resonance imaging for assessment of the endolymphatic sac and vestibular aqueduct.

STUDY DESIGN

Imaging and histological study of the cadaver.

METHODS

Five cadavers were studied by a 1.5-T magnetic resonance imaging system with a 3-inch-diameter surface coil. Magnetic resonance imaging scans were obtained with proton density-weighted and T2-weighted fast spin-echo sequences. Histological sections were made with an epoxy resin-embedding method and were compared with magnetic resonance imaging scans.

RESULTS

The visibility of the endolymphatic sac on both sequences corresponded well to the presence of the endolymphatic sac on histological sections. On the histological sections, the width of the external aperture of vestibular aqueduct (endolymphatic sac including surrounding connective tissue) was 0.96 +/- 0.18 mm (mean +/- SD) and the width of lumen of endolymphatic sac at the same point was 0.47 +/- 0.17 mm. The width of the endolymphatic sac was 1.02 +/- 0.19 mm on proton density-weighted images and was 0.81 +/- 0.15 mm on T2-weighted images. The widths of endolymphatic sac measured on proton density-weighted image and those of vestibular aqueduct on histological section did not show statistically significant differences (P >.05). On the other hand, the endolymphatic sac as measured on T2-weighted image tended to be smaller than the vestibular aqueduct (P <.05) and tended to be larger than the lumen of the endolymphatic sac (P <.0005).

CONCLUSION

Both sequences can precisely depict the endolymphatic sac; however, the proton density-weighted image is a more appropriate indicator of the actual anatomical configuration of the endolymphatic sac with surrounding connective tissue and vestibular aqueduct.

The variational anatomy of the external aperture of the human vestibular aqueduct

A study was undertaken to demonstrate the variational anatomy of the external aperture of the vestibular aqueduct in 90 human temporal bones obtained from 58 cadavers. Topographic landmarks of the posterior surface of the petrous bone are useful for general orientation and include the external aperture of the vestibular aqueduct, internal auditory meatus, sigmoid sinus, subarcuate fossa, superior petrosal sinus and cochlear canaliculus. We determined the mean distances from the external aperture of vestibular aqueduct to the above structures to be 10.98, 11.21, 9.42, 10.27 and 13.90 mm, respectively. Furthermore, the length of the external aperture of the vestibular aqueduct revealed significant differences between the right and left sides. The distances between the EAVA and certain anatomical structures on the posterior surface of the temporal bone should be taken into consideration during surgery. Knowing the variability of the position of the external aperture of the vestibular aqueduct may help surgeons avoid traumatizing, and thus producing inadvertent lesions to the hearing mechanism.

Normal modiolus: CT appearance in patients with a large vestibular aqueduct

PURPOSE

To determine the computed tomographic (CT) appearance of the normal modiolus and the pathologic alteration in patients with a large vestibular aqueduct and an otherwise normal-appearing cochlea.

MATERIALS AND METHODS

Temporal bone CT studies obtained before and after a major upgrade of CT capability in 1992 were reviewed in four groups: Group A (1.5-mm section thickness) comprised 50 normal ears in 43 patients, group B (1-mm section thickness) comprised 75 normal ears in 50 patients, group C (1.5-mm section thickness) comprised 16 ears with a large vestibular aqueduct in 10 patients, and group D (1-mm section thickness) comprised 23 ears with a large vestibular aqueduct in 12 patients. All groups comprised adult and pediatric patients.

RESULTS

In groups A and B, the normal modiolus was visualized in 90% and 100% of ears, respectively. In groups C and D, with a total of 39 ears with a large vestibular aqueduct and an otherwise normal cochlea, modiolar deficiency was demonstrated in 100% of ears.

CONCLUSION

CT is an excellent technique for depicting the cochlear modiolus. Results suggest that all ears with a large vestibular aqueduct have associated cochlear modiolar deficiencies. Thus, a large vestibular aqueduct may be only occasionally, if ever, an isolated developmental anomaly of the inner ear.

Computed radiographic measurement of the dimensions of the vestibular aqueduct in Menière's disease

Lateral polytomography of the vestibular aqueduct by computed radiography was carried out in 30 normal subjects and 25 patients with Meniere's disease, 14 of whom had bilateral involvement. The vestibular aqueduct could be identified clearly not only in normal subjects but also in patients with Menière's disease. Normal vestibular aqueducts were funnel-shaped or tubular, and the width of the external aperture was 6.0 mm on average. In contrast, a hypoplastic vestibular aqueduct with a narrow external aperture was often observed in patients with Menière's disease. Especially, in affected ears of patients with unilateral Menière's disease, the external aperture was very narrow; its mean width was 2.2 mm. In these cases, the most common radiographic configuration of the vestibular aqueduct was filiform. Meanwhile bilateral Menière's disease had a relatively wide external aperture compared with that of unilateral Menière's disease, although a hypoplastic vestibular aqueduct was also observed in patients with bilateral Menière's disease. As to the distribution of radiographic configuration types, bilateral Menière's disease had almost the same distribution as in normal ears. From these results, it was concluded that a hypoplastic development of the vestibular aqueduct was based on the etiology of Menière's disease, but general factors as well as a hypoplastic vestibular aqueduct seem to be responsible for bilateral involvement.

Anatomical variations of the human vestibular aqueduct. Part II. A radioanatomical study

The human vestibular aqueducts are classified into 3 types and into the types hyper-, normo- and hypoplastic. The types correspond with each other up to over 85%. For a better understanding of the radioanatomy and for the proper interpretation of radiograms, we describe the presence of a flat recess-like widening of the peripheral portion of the aqueduct, as well as other findings.

Three-dimensional course of the vestibular aqueduct

Three-dimensional (3-D) reconstruction methods were employed to study the anatomy of the vestibular aqueducts (VAs) in ten postmortem temporal bone specimens obtained from ten individuals aged 4 months to 70 years at death. After reconstruction, the ten 3-D images of VAs were superimposed on one another and differences evaluated. The VA showed postnatal growth and variations in size and shape. However, the variations in angle at which the VA bends near the isthmus were not correlated with age. Furthermore, study of the superimposed images revealed that the 3-D course of the VA was essentially the same in individuals of all ages, despite its wide variability in size and shape. These results indicate that the basic course of the VA is determined before early infancy although the VA grows thereafter, suggesting that VA anomalies such as "large vestibular aqueduct syndrome" (in which the VA takes an abnormally straight and wide course) may be established prenatally.

Reformatted planar 'Christmas tree' MR appearance of the endolymphatic sac

A high-resolution three-dimensional Fourier transform technique and prototype bilateral dual phased-array surface coil technique was used to make inner ear structures visible on MR. Multiplanar reformatted images, parallel to the plane of the vestibular aqueduct, allowed viewing of the entire endolymphatic sac/vestibular aqueduct on one section, producing a "Christmas tree" shape. The reformation was obtained using a double oblique angle, 45 degrees from true sagittal and 70 degrees from the orbital-meatal axis.

Postnatal development of the vestibular aqueduct in relation to the internal auditory canal. Computer-aided three-dimensional reconstruction and measurement study

To investigate a possible developmental relationship between the internal auditory canal (IAC) and the vestibular aqueduct (VA), we made the following measurements in 10 normal temporal bones from individuals 4 months to 70 years of age at death, using a computer-aided three-dimensional reconstruction and measurement method: the volume of the VA, the length of the IAC, and the distance between the IAC and the external aperture of the VA. The degree of periaqueductal pneumatization was also assessed qualitatively by means of a light microscope. The three parameters increased postnatally in parallel with the development of the periaqueductal air cells, and all pairwise comparisons of these parameters showed a statistically significant correlation. Our results indicate that the IAC and VA develop synchronously and in parallel with the development of the periaqueductal air cells. We believe that an understanding of this relationship will be of help during surgery involving the IAC and VA, and may shed some light on the morphological features of Meniere's disease.

Observation of the external aperture of the vestibular aqueduct using three-dimensional surface reconstruction imaging

Observation of the external aperture of the vestibular aqueduct was hitherto possible only in cadavers or dry temporal bones; however, by applying three-dimensional surface reconstruction imaging, it is now possible to observe solid-looking images of this structure in living humans. When the width of the external aperture of the vestibular aqueduct was measured in 58 people, it was found to be significantly narrower in the affected ears of patients with Meniere's disease than in normal ears.

[MR imaging of the vestibular aqueduct in normal volunteers and patients with Menière's disease--a preliminary report]

In this paper we attempted MR visualization of the vestibular aqueduct (VA) with a surface coil. Sagittal plane was most preferable from the result of preliminary study using a dry temporal bone. In all of ten normal volunteers, VAs were visualized well. In none of them, proton-density weighted spin-echo (SE) images were inferior to both T1- and T2-weighted SE image. In four of eight patients with Menière's disease, VAs were not visualized due to obstruction of VA, although in all of ten non-Menière's patients with hearing loss or vertigo, VAs were well visualized. Although further investigation is needed, MR imaging of VA including both its content and surrounding bony structure would give important information to manage the patients with either Menière's disease or other disorders of internal ears.

[Computer-aided three-dimensional reconstruction of the human vestibular aqueduct and the parvestibular canaliculus]

The vestibular aqueduct (VA) and paravestibular canaliculus (PVC) were reconstructed using a computer-aided three-dimensional reconstruction system (SERSERS) from five series of the serial, histopathological sections of the human temporal bones without alignment markers. In order to align the serial sections, more than ten sectional tissue structure images on a section such as the cochlea, VA, PVC, semicircular canals, ossicles and facial canal were compared with those on the consecutive section and the position was determined where the deviation of each sectional image pair would be the minimum in every direction. Repeating this procedure throughout the series of the sections, we could perform the overall alignment of the sections. As the standard viewing axis of reconstruction, we used the modiolus and constructed a triplet of images; posteromedial view image viewing from posterior surface side of the pyramis parallel to the modiolus, superior view image viewing from anterior surface side of the pyramis perpendicularly to the modiolus, anteromedial view image viewing from the internal carotid artery side perpendicularly to the modiolus. The triplet images of the cochlea, VA and PVC presented us their three-dimensional configuration and the spatial relationship among them. Superior view showed that the angle between the plane of the proximal portion of the VA and that of the basal turn of cochlea varied in a wide range from 53 degrees to 68 degrees. Anteromedial view showed that the angle between the plane of the distal portion of the VA and that of the posterior semicircular canal also varied in a wide range from 22 degrees to 49 degrees.(ABSTRACT TRUNCATED AT 250 WORDS)

Vestibular aqueduct in Menière's disease and non-Menière's disease with endolymphatic hydrops: a computer aided volumetric study

The volume of the vestibular aqueduct was studied by a computer-aided volumetric method in 9 temporal bones with endolymphatic hydrops from individuals with Menière's disease (MD), 7 temporal bones with endolymphatic hydrops from individuals without a history of Meniere's disease (non-MD hydrops), and 10 normal temporal bones (controls) to investigate the cause of endolymphatic hydrops in both MD and non-MD hydrops. A hypoplastic vestibular aqueduct was found significantly more often in the MD group than in either the non-MD hydrops group (chi 2-test, chi 2 = 4.063, p less than 0.05) or the control group (chi 2-test, chi 2 = 6.363, p less than 0.05). The difference in volume between the non-MD hydrops group and the control group was not significant. It is speculated that a small vestibular aqueduct (presumably containing a small endolymphatic sac) might be a predisposing factor in Menière's disease. In contrast, in non-MD hydrops, there seems to be no correlation of endolymphatic hydrops with a hypoplastic vestibular aqueduct and endolymphatic sac.

Correlation of high resolution computed tomography and gross anatomic sections of the temporal bone. Part III. Cochlear and vestibular aqueducts

Gross anatomic sections of isolated temporal bones (TB) were compared with high resolution computed tomography (CT) scans obtained utilizing contiguous 1.5-mm thick slices in the transaxial, coronal, and sagittal planes. Each TB was then sectioned at 2.0-mm intervals in planes parallel to those of the CT scans. Both the cochlear and vestibular aqueducts were best visualized in the coronal plane; the transaxial plane proved less reliable and the sagittal plane was not useful at all. The cochlear aqueduct in the coronal plane appears as a funnel-shaped configuration with its widest portion opening into the subarachnoid space. The vestibular aqueduct at its opening into the epidural space is well visualized in the coronal plane, and as it traverses the bone toward the vestibule it appears as an oval to spherical lucency, whereas in transaxial sections it is seen as a small longitudinal lucency.

Variations in surgical anatomy of the endolymphatic sac

Twenty-nine specimens of the extraosseous portion of the human endolymphatic sac (ES) were serially sectioned longitudinally. The length and width of the extraosseous ES were measured and the surface area was calculated. As the specimens included the sigmoid sinus (SS), the relationship between the ES and the SS was analyzed. The extraosseous ES varied considerably in size. The lumen either consisted of a single tube or was subdivided into several tubules. The distal part of the ES overlapped the SS in one third of the specimens. The results indicate that a minute extraosseous ES could explain the sometimes difficult task of localizing this structure at ES surgery. The great variability in size might perhaps also explain the varying results of this surgery.

Visualization of human vestibular aqueduct with computer-aided serial section reconstruction system

The computer-aided serial section reconstruction system (SERSERS) was employed to elucidate the entire configuration of the vestibular aqueduct in the human temporal bone. The advantages and the disadvantages of this system are discussed in comparison with several conventional methods such as X-ray visualization, plastic casting and graphic reconstruction. In spite of some limitations encountered, such as difficulty in placing a marker on each section or time consumption in data input, SERSERS can be useful in the study of the vestibular aqueduct, since a three-dimensional structure which can be observed from multidirectional aspects is reconstructed.

Anatomic basis for labyrinthine preservation during posterior fossa acoustic tumor surgery

Earlier diagnosis of acoustic tumors promises to increase our opportunity to identify patients with serviceable hearing. Critical to a posterior fossa transmeatal approach for acoustic tumor resection is preservation of the underlying labyrinth. Although the labyrinth has been recognized as a limiting factor in exposure of tumor in the internal auditory canal, few reports have detailed the microscopic surgical anatomy posterior to the internal auditory canal. An anatomic study was undertaken to determine consistent relationships between critical structures within the temporal bone relevant to hearing preservation surgery. The results of this study indicate that, whereas topographic landmarks are helpful for orientation, the more consistent relationship of the labyrinth to the vestibular aqueduct and singular canal allows a more accurate localization of the underlying labyrinth. Although the vestibule frequently prevents direct visualization of the transverse crest, a dissection based upon the microsurgical anatomy will maximize visualization of the lateral fundus while preserving the integrity of the labyrinth.

Endolymphatic duct and sac in patients with Meniere's disease. A temporal bone histopathological study

The endolymphatic ducts and sacs of 25 temporal bones with idiopathic endolymphatic hydrops from individuals with Meniere's disease were studied and compared with the same number of control bones without endolymphatic hydrops from individuals with no premortem history of otologic disease. The control bones were selected so that the sizes of their vestibular aqueducts matched those temporal bones from individuals with Meniere's disease. The endolymphatic ducts and sacs of all bones were studied by the medial view graphic reconstruction method and/or histological observation under a light microscope. In the endolymphatic duct and sac of many of the temporal bones from patients with Meniere's disease were noted a diminution of the width of the endolymphatic duct in its isthmus portion, an increase in the area of the collapsed lumen of the endolymphatic sac, fibrotic changes in the perisaccular loose connective tissue, and an increase in the quantity of intraluminal eosinophilic material. The frequencies with which these pathological findings were noted in bones from individuals with Meniere's disease and in control bones were statistically significantly different. No significant differences were observed under light microscopic study between these two groups with regard to the condition of the epithelial cells, the degree of rugosity of the endolymphatic sac, or the appearance of melanin-like pigmentation of hyalinization in the perisaccular connective tissue.

The vestibular aqueduct in patients with Meniere's disease. A temporal bone histopathological investigation

Meniere's disease (idiopathic endolymphatic hydrops) was studied in human temporal bone histology sections. Measurements were made of the area, length, width, angle, position, and external aperture of the vestibular aqueduct in 27 temporal bones of individuals with this disease. These measurements were compared with measurements of the same parameters in 88 normal temporal bones. It was found that small vestibular aqueducts were more often observed in the temporal bones of patients with Meniere's disease than in temporal bones from individuals without this disorder. The difference in size of the vestibular aqueduct in bones with hydrops and normal bones was statistically significant.

Vascular mechanisms in Meniere's disease

Normal venous drainage of the vestibular organs through the vein of the paravestibular canaliculus (PVC) may be crucial to inner ear fluid mechanics. It is proposed that increased venous pressure, with resultant venous insufficiency of the vestibular organs, may result in endolymphatic hydrops unless collateral venous circulation develops. Certain variations in pattern of venous drainage where the vestibular organs drain predominantly through the PVC vein may be a predisposing factor. In patients with Meniere's disease, different mechanisms can cause venous insufficiency. One suggested mechanism is morphologic change in the microcirculation of the intermediate portion of the endolymphatic sac. Microcirculation changes may be associated with fibrosis of the perisac tissues or shortening of the intermediate sac region or might be physiologically determined. Venous insufficiency may also result from anomalies of the PVC vein.

Postnatal development of the vestibular aqueduct and endolymphatic sac

The purpose of this study was to gain basic information about the postnatal development of the vestibular aqueduct (VA) and the endolymphatic sac (ES). For this study, serial horizontal sections of 31 normal temporal bones of individuals whose ages ranged from 0 to 13 years were used. Medial view graphic reconstruction of the VA and rugose portion (RP) of the ES was performed in every case for analysis of the VA and RP. The findings of this study revealed the following new information about the postnatal development of the VA and ES. 1) The VA and RP undergo significant growth postnatally up to age 3 years. 2) In the newborn, individual variations in the VA and RP already exist and at age 3 years significantly wide individual variations which can be classified into three groups (hypoplastic, normoplastic, hyperplastic) may be recognized. 3) Hypoplastic VAs are of two types: one is fairly elongated and tubelike while the other is short and funnel-shaped. The tubelike VA seems to be the prenatal form. 4) The changes that occur with development postnatally in the area of the VA are more closely related to the changes that occur in the length of the external aperture of the VA than they are to the changes that occur in the length of the VA. 5) Development of the area of the VA is closely correlated with development of the area of the RP.

Dimensional anatomy of the vestibular aqueduct and the endolymphatic sac (rugose portion) in human temporal bones. Statistical analysis of 79 bones

The purpose of this study was to investigate the anatomy of the vestibular aqueduct (VA) and rugose portion (RP) of the endolymphatic sac. Serial horizontal sections of 79 normal temporal bones of individuals aged 20 to 102 years were used. Medial view graphic reconstruction of the VA was performed for each specimen to determine the area, length, angle and position of the VA. The relationship between the width of the VA and the area of the VA, and the relationship between the degree of development of the VA and the degree of development of the temporal bone (periaqueductal pneumatization and the otic capsule in the periaqueductal region) were also investigated. Measurements of the RP were also made and further histological study of the RP was performed on 30 selected specimens. We found that 1) the VA in adult temporal bone varies in size and can be classified as hypoplastic, normoplastic, or hyperplastic; 2) many of the VAs in each group have similar sizes, although they vary in length, angle, or position; 3) all or most of the RP was located within the VA in all but one specimen, which had a hypoplastic VA (in this specimen more than half of the entire RP extended into the posterior cranial fossa); 4) the histology of the RP was characteristic in each type of VA; and 5) the degree of development of the VA seems to correlate with the degree of development of the otic capsule in the periaqueductal region.

Anatomy and physiology of the gerbil cochlear nucleus: an improved surgical approach for microelectrode studies

A new, improved surgical approach to the cochlear nucleus is developed in the gerbil. This new approach involves making a small hole in the lateral wall of the temporal bone located within the perimeter of the superior semicircular canal. Microelectrodes are passed through the intact parafloccular lobe of the cerebellum to the cochlear nucleus. One advantage of the new approach is that no removal of any CNS vasculature or neural tissue is necessary. Relations between the bulla, temporal bone and cochlear nucleus are presented in detail. The new approach is demonstrated by making single unit recordings from the cochlear nucleus and classifying response patterns as measured in PST histograms. All of the response types found in cat are found in the gerbil.

Course and contents of the paravestibular canaliculus

The purpose of this study is to describe the anatomy of the paravestibular canaliculus (PVC) in detail, especially its course in relation to the vestibular aqueduct (VA) and its vascular contents. Serial horizontal sections of 20 normal human temporal bones were stained either with hematoxylin and eosin, by Verhoeff-van Gieson's method, or by Mallorys method, and studied under the light microscope. Graphic reconstruction of the VA and the PVC was performed in some of the cases. In this study, the following new anatomical information on the common course and vascular contents of the PVC was obtained: 1) two PVC are present in the area near the vestibular orifice of the VA; 2) the PVC merges with the VA in the area near its cranial orifice without any particular branching, and does not enter the posterior cranial fosa; 3) veins course through the entire length of the PVC whereas arteries course only through the posterior cranial fossa side of the PVC. It appears that veins are the major contents of the PVC and that these veins represent the main venous drainage system from the vestibule. It also appears that arteries in the PVC supply the blood from the posterior cranial fossa mainly to the PVC itself.

Tomography of the vestibular aqueduct in ear disease

A controversy exists concerning whether or not roentgenographic narrowing or nonvisualization of the vestibular aqueduct is a specific sign for Meniere's disease. Of 190 ears that were evaluated, abnormal aqueducts were seen in 42.9% of ears with Meniere's disease, 45.4% of contralateral, noninvolved ears from patients with Meniere's disease, 41.3% of ears with diseases other than Meniere's disease, 30.4% of ears with no disease, and 51.6% of normal ears. Narrowing or nonvisualization of the vestibular aqueduct is a nonspecific roentgenographic sign that is seen in diseased, as well as in normal ears, and should not be used to make a diagnosis of Meniere's disease. Indications for polytomography in Meniere's disease include (1) preoperative evaluation of the aqueduct prior to endolymphatic shunt procedures and (2) exclusion of acoustic neurinomas or other organic causes of vertigo.