Greater superficial petrosal nerve dissection: back to front or front to back?
OBJECTIVE
To introduce a novel surgical technique for the dissection of the greater superficial petrosal nerve (GSPN) in the middle fossa approach.


METHODS
Interdural temporal elevation was performed with a front-to-back technique to preserve the GSPN in 12 sides of 6 injected cadaveric heads dissected through a middle fossa approach.


RESULTS
The GSPN emerged from the facial hiatus in a shallow bony groove proximally, ran into a deeper sphenopetrosal groove, and eventually reached the mandibular nerve. With front-to-back dissection, this nerve was easily identified at the posterior border of the mandibular nerve. Dissection from front to back minimized the retraction force applied to the proximal part of the GSPN, which was preserved in all specimens.


CONCLUSIONS
The temporal dura can be elevated safely with a front-to-back technique to preserve the GSPN and to help maintain the physiological integrity of the facial nerve.
Jittapiromsak
Pakrit
P
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
Sabuncuoglu
Hakan
H
Deshmukh
Pushpa
P
Nakaji
Peter
P
Spetzler
Robert F
RF
Preul
Mark C
MC
D002102:Cadaver; D035301:Cranial Fossa, Middle / Q000033:anatomy & histology / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D004210:Dissection / Q000379:methods*; D004388:Dura Mater / Q000033:anatomy & histology / Q000601:surgery; D005154:Facial Nerve / Q000033:anatomy & histology / Q000601:surgery*; D020220:Facial Nerve Injuries / Q000517:prevention & control; D005830:Geniculate Ganglion / Q000033:anatomy & histology / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D007765:Lacrimal Apparatus / Q000294:innervation; D008340:Mandibular Nerve / Q000033:anatomy & histology / Q000601:surgery; D008576:Meningeal Arteries / Q000033:anatomy & histology / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods*; D010275:Parasympathetic Nervous System / Q000033:anatomy & histology / Q000601:surgery*; D010579:Petrous Bone / Q000033:anatomy & histology / Q000601:surgery; D012668:Trigeminal Ganglion / Q000033:anatomy & histology / Q000601:surgery; D000159:Vestibulocochlear Nerve / Q000033:anatomy & histology / Q000601:surgery