title: Endoscopic sublabial transmaxillary approach to the rostral middle fossa.
abstract: OBJECTIVE
  The rostral middle fossa faces the temporal pole and is the endocranial anterosuperior aspect of the greater wing of the sphenoid. Standard approaches to this region, such as the subtemporal, pterional, or orbitozygomatic approaches, require significant brain retraction or manipulation of the temporalis muscle. We report an endoscopic sublabial transmaxillary approach to this cranial base region that avoids the aforementioned pitfalls.
  
  
  METHODS
  Ten adult cadaveric half heads were used to develop the endoscopic approach and to identify the salient surgical landmarks.
  
  
  RESULTS
  The approach was divided into three stages: entry into the maxillary sinus, entry into the infratemporal fossa, and entry into the middle fossa. A craniotomy of greater than 20 mm in diameter can be safely created in the rostral middle fossa. When coupled with image guidance, the approach provides the flexibility to tailor the size and location of the middle fossa craniotomy.
  
  
  CONCLUSIONS
  Although endonasal endoscopic approaches are increasing in popularity, the middle fossa has not been adequately accessed with these techniques. The endoscopic sublabial transmaxillary approach provides safe and direct access to the rostral middle fossa, eliminating the need for brain retraction, temporalis muscle manipulation, or an external incision. The approach also permits early devascularization of cranial- or dural-based lesions.
authors.affiliation: University of New South Wales, School of Medical Sciences, Sydney, Australia.
authors.forename: Bonnie C
authors.initials: BC
authors.lastname: Ong
authors.forename: Pankaj A
authors.initials: PA
authors.lastname: Gore
authors.forename: Michael B
authors.initials: MB
authors.lastname: Donnellan
authors.forename: Thomas
authors.initials: T
authors.lastname: Kertesz
authors.forename: Charles
authors.initials: C
authors.lastname: Teo
mesh_terms: D035301:Cranial Fossa, Middle / Q000033:anatomy & histology* / Q000601:surgery*; D006801:Humans; D008443:Maxillary Sinus / Q000033:anatomy & histology* / Q000601:surgery*; D044583:Neuroendoscopy / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*