Extended middle fossa approach with oticocondylar osteotomy

Abstract

The extended middle fossa approach with an oticocondylar osteotomy is more extensive than the anterior transpetrosal approach. The mandibular head is dislocated anterointeriory after transection of the mandibular neck, and the external auditory meatus is unroofed. By these two procedures, the middle fossa can be exposed widely with minimal brain retraction. Regions accessible with this approach include the suprasellar, petroclival, clival region from the posterior clinoid process down to the jugular tuberculum and the infratemporal region from the pterygoic fossa to the jugular foramen. Precise approximation of the transected mandibular neck with a titanium miniplate allows normal function of the temporomandibular joint. This approach can be used alone or in combination with the orbitozygomatic approach or the presigmoidal transpetrosal approach. This approach was used for 56 lesions, including 23 meningiomas, 8 craniopharyngiornas, 6 chordomas or chondrosarcomas, 4 trigeminal neurinomas, and other lesions. Malocclusion of the mouth resulting from reconstruction failure on mandibulotomy in the initial two cases and transient facial palsy resulting from retraction of the nerve during exposure of the mandibular neck in three cases were complications of this surgery. The extended middle fossa approach thus allows wide exposure of central and middle skull base lesions avoiding undue injury to the temporal region.