Part IV. Surgical Technique and Complications: Evolution of Transtemporal Bone Removal of Acoustic Tumors

Abstract

<h3>Middle Fossa Approach</h3> In 1958, I became interested in attempting to expose the internal auditory canal to remove otosclerotic foci from this area. My hope was that removal of these foci would relieve pressure on the eighth nerve and improve hearing.¹ With the aid of Theodore Kurze, MD, a technique was developed to approach the internal auditory canal but to avoid damage to the facial nerve, cochlea, and superior semi-circular canal. This approach was carried out through the middle fossa (Fig 1 *). The incision and temporal lobe elevation was the same as is used to approach the fifth nerve for tic douloureux surgery. Extradural elevation of the temporal lobe brings into view the greater superficial petrosal nerve as it exits the facial hiatus on the middle fossa face of the petrous pyramid. Starting at the facial hiatus it was found that by using the Zeiss operating microscope and