ARRS 2022 Abstracts

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E1176. Surgical Landmines in T-Bone: What Every Radiologist Should Report in a Pre-Operative CT
Authors
  1. Sahithi Sharma; Mayo Clinic - Phoenix
  2. Veena Gautam; Synergy Radiology Associates
Background
The temporal bone (T-bone) is a complicated part of head and neck. There are many important surgical landmarks in the T-bone such as position of jugular bulb, position of sigmoid sinus, and relative position of tegmen tympani, all of which must be assessed on every temporal bone CT scan; even more so if a mastoidectomy, either canal up or down, is contemplated. It is extremely easy to get overwhelmed with the convoluted anatomy and fail to note an important anatomic variant which may prove to be disastrous to ENT surgeons if they discover that in the OR. Therefore, it is extremely important for radiologists to incorporate these landmarks in our search pattern, examine, and include them in our reports.

Educational Goals / Teaching Points
The anatomy of the temporal bone is challenging. There are many surgical landmarks that must be assessed in any temporal bone CT if there is any indication for a surgery, either a canal up or canal down mastoidectomy, or any T-bone surgery for that matter. The most important of these are the position of the jugular bulb, position of the sigmoid sinus, and position of the mastoid tegmen relative to the tegmen tympani. The other important findings to look for would include an aberrant carotid artery, dehiscent semicircular canal, or facial canal dehiscence. The goal of this presentation is to give a graphic description of why these findings are important and how they can be determined on CT scans. We also describe a format in which key structures can be included in every temporal bone CT report.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The exhibit will describe the pertinent anatomy of T-bone with respect these important surgical landmarks; provide easy pictorial description of why it is important for radiologists to evaluate these structures; and present a report format in which these structures can be incorporated in every T-bone CT scan.

Conclusion
There are a few important structures that must be assessed on every CT of the temporal bone, especially if a surgery is contemplated. It is of utmost importance to know what to look for. Aided with a good understanding of what can prove to be a surgical landmine for surgical colleagues, we can make ourselves better radiologists and serve our patients well.