<p>A comprehensive understanding of the complex three-dimensional anatomy of the temporal bone and inner ear is critical for accurate diagnosis, assessment, and surgical planning in patients being evaluated for cochlear implantation. A systematic imaging approach enables radiologists to identify anatomic variants, predict surgical challenges, and contribute to safer, more effective cochlear implantation in children. Anatomical variations and congenital malformations may affect implant eligibility, alter surgical approach, and influence clinical outcome. This review provides an overview of the normal anatomy and imaging appearance of the mastoid, middle ear, and inner ear, with great emphasis on key anatomic variants and malformations relevant to preoperative evaluation. Characteristic imaging findings and clinical implications of common malformations are illustrated using examples from our institutional experience. Vascular and facial nerve variants with surgical relevance are also reviewed. Finally, postoperative imaging assessment of implant positioning, electrode integrity, and potential complications is discussed.</p> Graphical Abstract <p></p>