OBJECTIVE: To analyze postoperative complications after microsurgery for acoustic neuroma (AN) via the middle fossa approach (MFA).
Particularly, microsurgery via the middle fossa approach (MFA) has been proven to have excellent functional results in small ANs, which has been published by us and several other groups before [2-5].
Because surgical repair by way of a mastoid approach alone can be inadequate if there are multiple tegmen defects, a middle fossa approach
alone, or in combination with a transmastoid approach, should be considered in such cases.
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.
A craniotomy with subtotal petrous apicectomy was performed via a right middle fossa approach
for drainage of the cholesterol granuloma.
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
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 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.