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Skull base surgery. 1994 October; 4(4): 181–188.
PMCID: PMC1661812

Surgical Anatomy of the Extended Middle Cranial Fossa Approach


The extended middle cranial fossa approach includes removal of the petrous bone from its subtemporal surface in order to expose widely the internal auditory canal and the posterior fossa dura around its porus while preserving all the important and closely related anatomical structures. We have dissected 25 temporal bones and five fresh cadavers in order to define the limits of this approach. Measurements were obtained between the different structures to find reliable angles and distances that could guide working in this area. A new method of identification of the internal auditory canal is discussed based on the measurements taken.

The results of the present work showed wide variations in the different structures. The arcuate eminence was coincident with the superior semicircular canal in only 48% of bones. Dehiscence of the geniculate ganglion and of the internal carotid artery was noted in 16% and 20% of specimens, respectively. The angles measured between the different structures showed great variations. However, the angle between the internal auditory canal and superior petrosal sinus was constant. Though the extended middle cranial fossa is a versatile approach, it affords a limited access to the cerebellopontine angle. A thorough understanding of the complex and variable anatomy of this area is necessary should this approach be utilized.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Garcia-Ibanez E, Garcia-Ibanez JL. Middle fossa vestibular neurectomy: a report of 373 cases. Otolaryngol Head Neck Surg. 1980 Jul-Aug;88(4):486–490. [PubMed]
  • Kawase T, Toya S, Shiobara R, Mine T. Transpetrosal approach for aneurysms of the lower basilar artery. J Neurosurg. 1985 Dec;63(6):857–861. [PubMed]
  • House WF, Hitselberger WE, Horn KL. The middle fossa transpetrous approach to the anterior-superior cerebellopontine angle. Am J Otol. 1986 Jan;7(1):1–4. [PubMed]
  • Hitselberger WE, Horn KL, Hankinson H, Brackmann DE, House WF. The middle fossa transpetrous approach for petroclival meningiomas. Skull Base Surg. 1993;3(3):130–135. [PMC free article] [PubMed]
  • Parisier SC. The middle cranial fossa approach to the internal auditory canal -- an anatomical study stressing critical distances between surgical landmarks. Laryngoscope. 1977 Apr;87(4 Pt 2 Suppl 4):1–20. [PubMed]
  • Sanna M, Zini C, Mazzoni A, Gandolfi A, Pareschi R, Pasanisi E, Gamoletti R. Hearing preservation in acoustic neuroma surgery. Middle fossa versus suboccipital approach. Am J Otol. 1987 Nov;8(6):500–506. [PubMed]

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