Middle Fossa Approach: Technical Nuances and Applications

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Middle Fossa Approach: Technical Nuances and Applications

By Luciano Mastronardi 3 Videos FEATURING Luciano Mastronardi, Guglielmo Cacciotti, Carlo Giacobbo Scavo, Raffaelino Roperto

1,581 views

September 18, 2018

The extradural middle fossa approach (EMFA) is an anterior petrosectomy useful
for accessing lesions of ...
read more ↘ petroclival and cavernous sinus regions. It may be
included in combined petrosal approach and extended in the anterolateral
transcavernous approach.
To facilitate the first attempts with this relatively uncommon approach, during
dissections of human cadaveric injected heads and isolated temporal bones, we
developed a simple learning method useful for localizing all anatomical
structures.
Technically, EMFA is a demanding interdural dissection, that provides a wide
exposure of an extradural corridor between the middle meningeal artery, 5th
cranial nerve, gasserian ganglion, 7th cranial nerve, geniculate ganglion, and 8th
cranial nerve, internal carotid artery (C5-C6 tract and the GSPN above), arcuate
eminence, cochlea, petrous apex, and petro-clival junction.
Its major advantages are that it offers extradural dissection, limits the temporal
lobe retraction, and avoids the transposition of nerves or vessels. Its
disadvantages are primarily related to the complicated anatomy of petrous apex
from the middle fossa trajectory, which can be unfamiliar.
Using this "rule of two fans," vascular, nervous, fibrous, and osseous structures
are localized within two bordering fans with a 90-degree relationship to each
other.
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