A Novel Minimally Invasive Approach to the Middle Cranial Fossa: Surgical Technique and Clinical Outcomes

Abstract

Background: Middle fossa craniotomy is an established surgical approach to manage lateral skull base pathology, such as superior canal dehiscence (SCD) or tegmen defects resulting in encephalocele and/or cerebrospinal fluid (CSF) leak. Traditionally described surgical incisions for MFC consist of a straight or curved pre-tragal vertical incision, or a large “C-shaped” incision, designed to facilitate a craniotomy of ~5x5cm (25cm2). Such an approach maximizes surgical exposure at the cost of a large incision and potential cosmetic deformity. In an attempt to optimize cosmetic outcomes in non-tumor MFC surgery, we have designed a minimally invasive approach characterized by a horizontally oriented S-shaped incision placed entirely within the hair-bearing skin, an anteroinferiorly based temporalis muscle flap, and small craniotomy. We hypothesize that our minimally invasive approach provides adequate exposure for management of non-tumor lateral skull base pathology with minimal postoperative morbidity.