Dissection of Extended Middle Fossa and Anterior Petrosectomy Approach

The extradural subtemporal approach through the middle fossa (MF) has become one of the most frequently used operative procedures in contemporary skull base of surgery. This approach is commonly used for exposing lateral wall of the cavernous sinus, to resect anterior petrous bone or to open the internal auditory canal. The MF surgery will be utilized for excision of intracanalicular acoustic neuromas, petrous and infracavernous chordomas, trigeminal neuromas, and small to medium size petroclival meningiomas. Full understanding of microanatomical structure of the cavernous sinus region, middle fossa, and the rhomboid construct is essential for this approach. Through this exercise the surgeon will acquire operative techniques to perform the anterior petrosectomy and also to expose the IAC through the middle fossa.