Middle fossa approach: Applications in temporal bone lesions

Area of Science:

• Neurosurgery
• Otolaryngology
• Skull Base Surgery

Background:

• The middle fossa approach is a valuable technique for lateral skull base surgery.
• Its technical complexity, however, limits its indications and application.

Purpose of the Study:

• To present the surgical experience with the middle fossa approach in 10 patients with complex lateral skull base lesions.
• To evaluate the safety, efficacy, and outcomes of this approach in challenging cases.

Main Methods:

• Retrospective case series of 10 patients undergoing the middle fossa approach for complex skull base pathologies.
• Analysis of surgical outcomes, including mortality, complications, facial nerve function, hearing preservation, and lesion resolution.

Main Results:

• No mortality was observed. Two patients experienced postoperative complications (epidural and cortico-subcortical hematomas).
• Facial nerve function (House/Brackmann I-II) was achieved in 8 patients; no deterioration occurred in the remaining two.
• Hearing function was preserved in 5 of 7 patients with adequate pre-operative hearing. Complete lesion resolution was achieved in 9 out of 10 patients.

Conclusions:

• The middle fossa approach is a safe and reliable technique for lateral skull base surgery, providing excellent control and exposure.
• It represents a crucial, and sometimes the only, viable surgical option for specific complex skull base pathologies.
• Mastery of this approach is essential for neurosurgeons and skull base specialists.