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Diseases involving the proximity of the internal carotid artery at the skull base require identification of this vessel in the temporal bone to gain vascular control for any maneuver in its vicinity. This article details the technique of surgical dissection and exposure of the internal carotid artery within the skull base through a transtemporal middle cranial fossa approach. The anatomic landmarks important in utilizing this procedure include the greater superficial petrosal nerve, the mandibular branch of the trigeminal nerve, and the middle meningeal artery. With this approach, the internal carotid artery can be followed throughout the carotid canal and beyond the formen lacerun to the region of the cavernous sinus. The indications and limitations of this procedure are described and several clinical applications are provided.