title: The middle fossa approach and extended middle fossa approach:  technique and operative nuances.
abstract: BACKGROUND
  The middle fossa approach and extended middle fossa approach, also known as the anterior transpetrosal approach, are cranial base techniques for addressing small vestibular schwannomas, medial temporal bone lesions, midbasilar trunk aneurysms, and selected petroclival lesions.
  
  
  OBJECTIVE
  To provide an outline of a number of technical nuances that are important to correct application of these approaches, maximizing exposure, and limiting potential morbidity.
  
  
  METHODS
  Via a temporal craniotomy, the petrous apex is removed in variable degrees, depending on the exposure requirements of the lesion. The technique is described in detail with appropriate nuances of the technique provided.
  
  
  RESULTS
  The described nuances of technique in the performance of the approaches have resulted in successful application of these techniques in a significant number of cases.
  
  
  CONCLUSIONS
  Significant familiarity and practice with these surgical approach techniques are critical to applying them safely to clinical problems. A number of technical details can assist the surgeon in achieving optimal exposure and limited morbidity.
authors: University of Arkansas for Medical Sciences, Department of Neurosurgery, 4301 W Markham, No. 507, Little Rock, AR 72205, USA. jdday@uams.edu
authors: J
authors: J
authors: Diaz Day
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D035301:Cranial Fossa, Middle / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery*; D055815:Young Adult