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The aim of this study was to define the middle ear as a route to the fundus (lateral end) of the internal acoustic canal and to propose feasible landmarks to the fundus.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>This was a cadaveric study; 34 adult cadaveric temporal bones and 2 dry bones were dissected with the aid of the endoscope and microscope to show the anatomy of the transcanal approach to the middle ear and fundus of the internal acoustic canal.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>In the middle ear cavity, the cochleariform process is one of the key landmarks for accessing the fundus of the internal acoustic canal. The triangle formed by the anterior and posterior edges of the overhang of the round window and the cochleariform process provides a landmark to start drilling the bone to access the fundus of the internal acoustic canal.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>The external acoustic canal and middle ear cavity combined, using endoscopic guidance, can provide a route to the fundus of the internal acoustic canal. A triangular landmark crossing the promontory has been described for reaching the meatal fundus. This transcanal approach requires an understanding of the relationship between the middle ear cavity and the fundus of the internal acoustic canal and provides a potential new area of cooperation between otology and neurosurgery for accessing pathology in this and the bordering skull base.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2016.5.jns16261","type":"journal-article","created":{"date-parts":[[2016,9,2]],"date-time":"2016-09-02T14:00:17Z","timestamp":1472824817000},"page":"1974-1983","source":"Crossref","is-referenced-by-count":8,"title":["The endoscopic anatomy of the middle ear approach to the fundus of the internal acoustic canal"],"prefix":"10.3171","volume":"126","author":[{"given":"Noritaka","family":"Komune","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan;"},{"name":"Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satoshi","family":"Matsuo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koichi","family":"Miki","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Graduate School of Medical Sciences, Fukuoka University, Fukuoka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Albert L.","family":"Rhoton","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida; and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-jns16261","series-title":"Eur J Radiol","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1016\/0720-048X(95)00619-2","article-title":"Computed tomographic evaluation of surgically significant vascular variations related with the temporal bone","volume":"20","author":"Atilla S,","year":"1995","unstructured":"Atilla S, Akpek S, Uslu S, Ilgit ET, I\u015fik S: Computed tomographic evaluation of surgically significant vascular variations related with the temporal bone. 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