Middle Fossa Approach to the Temporal Bone: An Otologic Frontier

Abstract

THE MIDDLE fossa approach to the temporal bone has made possible a whole new concept of surgery at the base of the skull. It is the purpose of this paper to discuss the indications, technique, and morbidity of this approach as used by the Otologic Medical Group. <h3>History</h3> The classic neurosurgical approach to the middle fossa was first described in 1891 by Frank Hartley.¹His intracranial, extradural route to the trigeminal ganglion was the basis upon which most operations for trigeminal neuralgia have been patterned. About 1½ years later, Fedor Krause duplicated Hartley's work (unaware of it) and in 1895 reported 51 gasserian ganglionectomies with an overall mortality of 10%. Harvey Cushing modified the Hartley-Krause approach by minimizing traction on, and subsequent hemorrhage from, the middle meningeal artery. He was thus able to lower the mortality to 5% by 1905.²Ruge et al,³reporting a series