How to Perform Middle Fossa/Sphenoid Wing Approaches

Abstract

The skull base is a very complex anatomical region with an irregular bony architecture, which is classically divided into anterior, middle, and posterior compartments called fossae. The presence of dural folds, blood vessels, and cranial nerves provides a surgical challenge for even the most experienced neurosurgeon. Several approaches have been described to reach different parts of the middle fossa. These skull base approaches usually require bony drilling for exposure, to control the tumor blood supply, and to minimize brain retraction. Knowledge of anatomy acquired in the laboratory, as well as learning to handle relevant microinstrumentation, including microdrills, is of paramount importance for the young neurosurgeon who is interested in the difficult field of skull base surgery.