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Subfascial dissection and extended temporal muscle detachment for middle fossa approach

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Abstract

Background

The soft tissue dissection for the middle fossa approach requires adequate management of the neuro, vascular, and muscular structures in order to maximize exposure and diminish morbidities.

Methods

An incision anterior to the tragus is performed, extending from the zygomatic process to the superior temporal line. The superior temporal artery is exposed, followed by a subfascial dissection of the frontalis nerve. The temporal muscle is dissected and released from the zygoma. All cranial landmarks are exposed for the 5 × 5 cm temporal fossa craniotomy.

Conclusion

This novel approach provides a safe and adequate access to perform an extended middle fossa craniotomy.

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Data Availability

The data about the surgical approach and and anatomical landmarks are available under request for the corresponding author.

References

  1. Angeli S (2012) Middle fossa approach: indications, technique, and results. Otolaryngol Clin North Am 45(2):417–438

    Article  PubMed  Google Scholar 

  2. Day JD (2012) The middle fossa approach and extended middle fossa approach: technique and operative nuances. Oper Neurosurg 70(2):192–201

    Google Scholar 

  3. House W, Shelton C (1992) Middle fossa approach for acoustic tumor removal. Otolaryngol Clin North Am 25(2):347–359

    Article  CAS  PubMed  Google Scholar 

  4. Kawase T, Toya S, Shiobara R, Mine T (1985) Transpetrosal approach for aneurysms of the lower basilar artery. J Neurosurg 63(6):857–61. https://thejns.org/view/journals/j-neurosurg/63/6/article-p857.xml

    Article  CAS  PubMed  Google Scholar 

  5. Lipschitz N, Kohlberg GD, Zuccarello M, Samy RN (2018) Comprehensive review of the extended middle cranial fossa approach. Curr Opin Otolaryngol Head Neck Surg 26(5):286–292. https://journals.lww.com/co-otolaryngology/Fulltext/2018/10000/Comprehensive_review_of_the_extended_middle.5.aspx

    Article  PubMed  Google Scholar 

  6. Peris-Celda M, Perry A, Carlstrom LP, Graffeo CS, Driscoll CLW, Link MJ (2019) Key anatomical landmarks for middle fossa surgery: a surgical anatomy study. J Neurosurg 131(5):1561–1570

    Article  Google Scholar 

  7. Shibao S, Borghei-Razavi H, Orii M, Yoshida K (2015) Anterior transpetrosal approach combined with partial posterior petrosectomy for petroclival meningiomas with posterior extension. World Neurosurg 84(2):574–579

    Article  PubMed  Google Scholar 

  8. Sriamornrattanakul K, Akharathammachote N, Wongsuriyanan S (2021) Suprafascial dissection for pterional craniotomy to preserve the frontotemporal branch of the facial nerve with less temporal hollowing. Surg Neurol Int 12(559):1–11

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Acknowledgements

The authors would like to thank Dr. Saniya S. Godil, MD, MSCI; Dr. Kyle C. Wu, MD; Dr. Mohammad B. Asawaf, MD; and Joshua Vignolles-Jeong, BA, for their help in this project.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, The Ohio State University Wexner Medical Center, Doan Hall N 1049, 460 W 10Th Ave, Columbus, OH, 43210, USA

    Guilherme Finger & Daniel M. Prevedello

  2. Department of Otolaryngology and Skull Base Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Vivian F. Kaul & Oliver F. Adunka

Authors
  1. Guilherme Finger
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  2. Vivian F. Kaul
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  3. Oliver F. Adunka
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  4. Daniel M. Prevedello
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Corresponding author

Correspondence to Guilherme Finger.

Ethics declarations

Ethical approval

This project was approved by the ethical board of the institution.

Informed consent

The patient consented to have parts of his surgery demonstrated in this video.

Conflict of interest

The authors declare no competing interests.

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Key points

1. Supine position with the head turned to the contralateral side and parallel to the floor.

2. Linear incision 1 cm anterior to the tragus, extending from 1 cm below the zygomatic process to 1 cm above the superior temporal line.

3. Exposure of STA with coagulation and cutting of the parietal branch.

4. Subgaleal dissection exposes the junction between the superior orbital rim and the superior temporal line at its anterosuperior limit, and the root of the zygomatic process posteroinferiorly.

5. Subfascial dissection.

6. Superficial temporalis fascia and associated fat pad are reflected anteriorly.

7. Temporal muscle subperiosteal dissection from posterior to anterior and from inferior to superior.

8. Anterior dissection of the temporal muscle.

9. Identify all cranial landmarks exposed.

10. Perform a 5 × 5 cm temporal fossa craniotomy.

This article is part of the Topical Collection on Neurosurgical technique evaluation

Supplementary information

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Finger, G., Kaul, V.F., Adunka, O.F. et al. Subfascial dissection and extended temporal muscle detachment for middle fossa approach. Acta Neurochir 165, 3473–3477 (2023). https://doi.org/10.1007/s00701-022-05483-5

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  • DOI: https://doi.org/10.1007/s00701-022-05483-5

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