Ahead of Print: Dural Landmark To Locate the Internal Auditory Canal in Large and Giant Vestibular Schwannomas: the Tubingen Line

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BACKGROUND: In cases of large and giant vestibular schwannomas (VS), the visualization of the internal auditory canal (IAC) opening is difficult or impossible.

OBJECTIVE: To describe the Tubingen line and explores its relationships with the IAC as a landmark to help locate the IAC.

METHODS: Ten cadaveric heads were used in this study. Between 2004 and 2009, the senior author (MT) used the Tubingen line as a landmark to recognize the IAC in 300 consecutive patients with VS. To locate the Tubingen line, the initial step was to identify several vertical foldings of dura located around the area of the vestibular aqueduct. Following this, foldings upward consistently reached a linear level where all of the foldings ended and the dura tightly adhered to the bony surface in a smooth, foldless shape.