A new technique for wide-field exposure of the base of the skull

Surgical exposure of the extracranial surface of the floor of the middle and posterior cranial fossa is difficult using the available techniques of skull base surgery. Considering this problem, cadaver dissections were performed and a new approach to the skull base developed. The parapharyngeal space is entered through a transcervical incision combined with a median labiomandibulotomy. This allows control of the major neurovascular structures up to their entrance at the skull base. The Eustachian tube is divided between the base of the skull and Rosenmüller's fossa. This allows the pharynx to be detached from the skull base and retracted to the contralateral side, exposing both the clivus and upper cervical vertebrae. Exposure of the posterior nasal cavity and body of the sphenoid is obtained by a transpalatal approach. The sphenoid sinus can be entered and, if necessary, the dissection extended to the pterygomaxillary space and anterior skull base. Herein, this technique is described in detail, as are the various disease states in which it may be indicated and its application in a representative clinical case.