Anatomy of the Middle Cranial Fossa with Reference to the Subtemporal Approach, Transtentorial Approach, and Middle Fossa Approach

Abstract

In the subtemporal approach to the middle cranial fossa, part of the temporal muscle is usually detached with a piece of the lateral cranial wall (temporal squama, greater wing of sphenoid) and reflected downward. The route of surgical approach, the branches of the superficial temporal artery, the temporal muscle, the middle temporal vein, and the deep temporal arteries are discussed in connection with the pterional approach. The depth of the temporal fossa during postnatal life is illustrated in Fig. SA 53 (from Lang and Gotzfried 1982). The lowest point of the middle cranial fossa (and the FHP) is roughly level with the upper border of the zygomatic arch and is slightly posterior to the articular tubercle of the temporomandibular joint. The upper part of the zygomatic arch may be burred away to make room for the necessary downward reflection of muscle and bone (Spetzler, personal communication 1986). The floor of the middle cranial fossa is bounded anteriorly and inferiorly by the greater wing of the sphenoid, by the temporal squama in the area of the surgical approach, and posteriorly by the anterior surface of the petrous part. It should be noted that impressions of the temporal gyri may greatly thin the temporal squama (see Lang 1983 for details). The floor of the middle fossa is also thin: 1) About the articular fossa of the temporomandibular joint. 2) In front of the foramen ovale and lateral to the foramen rotundum.