Subfascial dissection and extended temporal muscle detachment for middle fossa approach.

Abstract

The soft tissue dissection for the middle fossa approach requires adequate management of the neuro, vascular, and muscular structures in order to maximize exposure and diminish morbidities. An incision anterior to the tragus is performed, extending from the zygomatic process to the superior temporal line. The superior temporal artery is exposed, followed by a subfascial dissection of the frontalis nerve. The temporal muscle is dissected and released from the zygoma. All cranial landmarks are exposed for the 5 × 5cm temporal fossa craniotomy. This novel approach provides a safe and adequate access to perform an extended middle fossa craniotomy.