The purpose of this case report--which involved a 66-year-old woman who was referred to our clinic for evaluation of severe headaches, dizziness, and left sided pulsatile tinnitus--is to demonstrate the definitive need for an extended middle fossa approach when a bilobed petrous apex mass is encountered.
In this article, the author describes a new case of petrous apex cholesterol granuloma to illustrate the definitive need for an extended middle fossa approach when a bilobed petrous apex mass is encountered.
If CT and MRI suggest that a petrous apex granuloma is lobulated and septated, an extended middle fossa approach for drainage and aeration is necessary to ensure complete drainage.
received the award for his presentation, "Long-Term Follow-Up, Results and Complications of the Middle Fossa Approach
for Hearing Preservation in Acoustic Neuromas.
We used the middle fossa approach
for all 51 operations.
Different surgical approaches have been described as definitive treatments, but a mastoid approach, a middle fossa approach
, or a combination of both is recommended.
Between June 1, 1984, and June 30, 1993, we surgically treated 220 cases of traumatic facial paralysis with good cochlear reserve by decompressing the tympanic and mastoid segments via a transmastoid approach followed by decompression of the geniculate ganglion and the distal half of the labyrinthine segment via a middle fossa approach.
The middle fossa approach to the anterosuperior surface of the petrous pyramid has been used by neurotologists to excise small acoustic neuromas, to denervate the vestibular labyrinth, and to decompress and repair the proximal intratemporal facial nerve.
16) In subsequent years, the use of the middle fossa approach
was not uncommon, but it never achieved widespread popularity, largely because of its technical difficulty, limited applicability in older patients, and high incidence of complications, including hearing loss and facial weakness.
The middle fossa approach provides neurotologic surgical access to lesions of the geniculate ganglion and the labyrinthine portion of the facial nerve as well as to the internal acoustic canal, and therefore helps preserve cochlear function.
The middle fossa approach was first used during the latter part of the 19th century as a means of exposing the trigeminal ganglion.
The surgical approaches used to achieve skull base access to the petrous apex in the 8 operated patients were an orbitocraniozygomatic approach in 4 patients, a middle fossa approach
in 2, and a transmastoid approach in 2.