The subtemporal and preauricular infratemporal approach for removal of skull base chordomas and chondrosarcomas

Abstract

The subtemporal and preauricular infratemporal fossa approach provides direct access to the middle cranial fossa, petrous bone, clivus, and cavernous sinus. This approach is ideally suited for use in the resection of chordomas and chondrosarcomas because most are extradural tumors. This approach requires a thorough knowledge of the surgical anatomy of the middle cranial fossa, cavernous sinus, temporal bone, and clivus. A frontotemporal craniotomy is made, and an orbitozygomatic osteotomy is performed to provide a low approach to this area. Dissection is performed extradurally under the temporal lobe to identify the petrous segment of the internal carotid artery. The artery is exposed completely in its entire course through the temporal bone and displaced laterally. The temporal bone and clivus are drilled medial to the petrous internal carotid artery. The surgeon approaches the area in front of the brainstem from an anterolateral direction.