The middle fossa approach, as popularized by William Fouts House, provides excellent exposure to the internal auditory canal (IAC) for the removal of small vestibular schwannoma with the potential for hearing preservation. The anterior extension of this approach described by Kawase (Kawase approach) enhances the surgical exposure provided by this route to the upper clivus and petrous apex.

The surgical technique for the middle fossa approach which includes an anterior-to-posterior elevation of middle fossa dura starting from the foramen ovale and uses the angle between the internal auditory meatus IAM and the long axis of the greater superficial petrosal nerve (GSPN) to localize the meatus from above may be an alternative to previously proposed surgical methods 1).

Lateral transzygomatic middle fossa approach

Tegmen tympani defect

Middle Fossa Approach for vestibular schwannoma 2).

Middle Fossa Approach for Facial Nerve Schwannoma.

The Middle Fossa Approach and Extended Middle Fossa Approach 1

The Middle Fossa Approach and Extended Middle Fossa Approach 2

The Middle Fossa Approach and Extended Middle Fossa Approach 3

Tanriover N, Sanus GZ, Ulu MO, Tanriverdi T, Akar Z, Rubino PA, Rhoton AL Jr. Middle fossa approach: microsurgical anatomy and surgical technique from the neurosurgical perspective. Surg Neurol. 2009 May;71(5):586-96; discussion 596. doi: 10.1016/j.surneu.2008.04.009. Epub 2008 Jul 9. PubMed PMID: 18617228.
Colletti V, Fiorino F. Is the middle fossa approach the treatment of choice for intracanalicular vestibular schwannoma? Otolaryngol Head Neck Surg. 2005 Mar;132(3):459-66. PubMed PMID: 15746862.
  • middle_fossa_approach.txt
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