Transtemporal approach to the skull base: an anatomical study.

Area of Science:

• Neurosurgery
• Surgical Anatomy
• Skull Base Surgery

Background:

• The transtemporal approach is a complex surgical technique for accessing skull base pathologies.
• Detailed anatomical understanding is crucial for safe and effective surgical navigation.

Observation:

• Dissections in 10 cadaver heads defined the transtemporal approach to the clivus.
• Specific steps involved exposing cervical neurovascular structures, performing craniotomies, and drilling petrous/tympanic bone.
• Lower clival exposure involved sigmoid sinus ligation, facial nerve displacement, and preservation of inner ear structures.
• Middle clival exposure required drilling the labyrinth and cochlea, with facial nerve displacement.

Findings:

• The transtemporal approach provides access to the lower clivus, exposing the medulla, pontomedullary junction, vertebral arteries, and caudal cranial nerves.
• Exposure of the middle clivus reveals the pons, basilar artery, and relevant cranial nerves (V, VI, VII, VIII).
• The approach offers limited exposure to upper clival structures, necessitating medial temporal lobe retraction.

Implications:

• This anatomical definition aids surgeons in planning and executing transtemporal approaches for clival lesions.
• The approach is applicable for treating vertebrobasilar system aneurysms, as illustrated by case reports.
• Understanding the advantages and limitations of this surgical corridor is vital for patient selection and outcomes.