[Enlarged middle fossa approach to the cerebello-pontine angle. Technique and indications]

Abstract

Our enlarged middle fossa approach, first published in 1982, aims to expose the internal auditory meatus and cerebello-pontine angle from above, with preservation of the cochlea and labyrinth. The steps of the operation are described, especially certain technical details: the skin incision, resection of the squamous temporal bone, extradural exposure of the petrous temporal bone, subsequent resection of the middle meningeal artery and superior petrosal sinus, extensive bone removal behind and in front of the internal auditory meatus, opening of the dura mater to expose the brain stem, and plastic closure of the defects. Believing in the advantages of this approach, we have modified the technique for various indications, including decompression of the facial and cochleovestibular nerves for cases of vascular compression and Menière's disease; management of temporal bone fractures with CSF leak of facial nerve damage; extensive cholesteatoma of the petrous bone; meningiomas or other tumours of the petrous bone; neuromas of the facial or vestibular nerve. It should be emphasised that the middle fossa approach may be combined with other approaches in the resection of lateral skull base tumours with preservation of the inner and middle ear.