Subfascial dissection and extended temporal muscle detachment for middle fossa approach

Acta Neurochir (Wien). 2023 Nov;165(11):3473-3477. doi: 10.1007/s00701-022-05483-5. Epub 2023 Jan 10.

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.

Keywords: Craniotomy; Dissection; Facial nerve injuries; Middle cranial fossa; Temporal muscle.

MeSH terms

  • Craniotomy
  • Humans
  • Muscle, Skeletal / surgery
  • Skull* / surgery
  • Temporal Muscle* / diagnostic imaging
  • Temporal Muscle* / innervation
  • Temporal Muscle* / surgery
  • Zygoma / innervation
  • Zygoma / surgery