title: Technical refinements in retraction for middle fossa surgery.
abstract: OBJECTIVE
  This report describes an alternative technique for exposure of the floor of the middle fossa.
  
  
  METHODS
  Descriptive review of alternative middle fossa retraction techniques on a retrospective case series.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Patients undergoing middle fossa or combined petrosal craniotomy were studied.
  
  
  METHODS
  Dural elevation was carried anteriorly past the middle meningeal artery to permit separation of the dura from connective tissue over the Gasserian ganglion. With the dural release, flexible spatula retractors (Fukushima) can be used.
  
  
  RESULTS
  The advantages of this technique are 1) this system is "low profile," with the back of the retractor posing no obstruction to vision or angle of instrument manipulation; 2) the anterior dural release permits extensive exposure with less force than is necessary when dural attachments to the trigeminal nerve remain intact; and 3) anterior exposure of the clivus and petrous apex is achieved without the need for transection of V3 (3rd division fifth cranial nerve).
  
  
  CONCLUSIONS
  The authors find these refinements of practical benefit for breadth of exposure, visibility, and room for instrumentation during middle fossa surgery.
authors.affiliation: Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania 15212, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Chen
authors.forename: M A
authors.initials: MA
authors.lastname: Arriaga
authors.forename: T
authors.initials: T
authors.lastname: Fukushima
mesh_terms: D001921:Brain / Q000601:surgery; D003399:Craniotomy / Q000379:methods*; D006801:Humans; D012189:Retrospective Studies; D012886:Skull / Q000601:surgery*; D013523:Surgical Equipment / Q000592:standards*; D013525:Surgical Instruments / Q000592:standards