Middle fossa approach

Please see attached PDFs below. 

Procedure

• 1. Rotate the mastoid as if sitting at the patient's head

  2. Create a window (~ 2 inches square) in the floor of the middle fossa (MF) superior and anterior to the EAC

1. Identify: 

   • Middle meningeal artery and trace it to the foramen spinosum 

     • Greater superficial petrosal nerve entering the facial hiatus and trace it to the geniculate ganglion

     • Arcuate eminence 

• 1. Open the roof of the middle ear

  2. Follow the labyrinthine facial nerve past the ampullated end of the SCC, skeletonize the nerve and identify:

• • Bill's Bar

• 1. Skeletonize the IAC and identify:

• • SCC

  • Cochlea

  • Superior vestibular nerve

  • Carotid artery 

Links 

• • YouTube video from Neurosurgery Journal on Middle Fossa and Extended MF Approach 

  • Brief guide and video from OtoSurgery.org on MF Approach 

  • Surgical technique from Iowa Protocols on MF Approach to CPA tumors