![]() The right cerebral hemisphere is removed and the dura of the middle fossa is peeled away. Primary anatomic structures of the middle fossa. Because the approach is from the superior surface of the temporal bone, the risk of inadvertently opening the posterior semicircular canal is less than that associated with the retrosigmoid approach, which involves drilling the posterior wall of the IAC. It is useful whenever the above segments of CN VII need to be decompressed. Depending on the size of a lesion, the possibility for preserving hearing with the middle fossa approach is good. It is useful for removing small lesions (up to 2 cm in diameter), primarily intracanalicular, with minimal extension into the posterior fossa. It permits exposure of the subarachnoid, intracanalicular, and labyrinthine segments, and the first portion of the horizontal (tympanic) segment of CN VII. The technique was abandoned, but its utility for removing acoustic neuromas was evident.Ĭompared to other approaches to the IAC, the middle fossa approach adequately exposes the facial (CN VII) and superior vestibular nerves within the IAC. They performed 14 cadaveric dissections and described the approach for decompression of the IAC for the treatment of otosclerosis. Theodore Kurze, a neurosurgeon, revisited this surgical approach. In 1961 William House, an eye, nose, and throat surgeon working with Dr. ![]() At that time exposure of this nerve was associated with a high rate of morbidity. In 1904 Parry first described the middle fossa approach for vestibular nerve section. This article focuses on the most relevant anatomical and technical aspects involved with accessing the IAC and with removing the petrous apex when greater exposure is needed. The anterior extension of this approach described by Kawase enhances the surgical exposure provided by this route to the upper clivus and petrous apex. The middle fossa approach, as popularized by William House, provides excellent exposure to the internal auditory canal (IAC) for the removal of small acoustic tumors with the potential for hearing preservation. Key Words: acoustic neuromas, facial nerve, middle fossa approach, petrosectomy The approach is versatile because it can be extended anteriorly by drilling the petrous apex (Kawase’s triangle) and gaining access to the posterior fossa and petroclival area. The middle fossa approach is a useful option for small lesions when hearing might be preserved. Cadaveric dissections are used to illustrate the anatomy relevant to this surgery. The internal auditory canal can be approached through the middle fossa by following anatomic landmarks. Joseph’s Hospital and Medical Center, Phoenix, Arizona 4, 2000 / The Middle Fossa Approachĭivision of Neurological Surgery, Barrow Neurological Institute, St. ![]() Home / For Providers & Researchers / Education / Grand Rounds, Publications, & Media / Barrow Quarterly / Volume 16, No. Barrow-ASU Center for Preclinical Imaging.Department of Translational Neuroscience.Department of Physical Medicine & Neuro-Rehabilitation.Department of ENT and Skull Base Surgery.Bioskills & Neurosurgery Research Laboratory.For Providers & Researchers Show submenu.Parkinson’s Disease & Movement Disorders.Center for Transitional Neuro-Rehabilitation. ![]()
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