Comprehensive review of the extended middle cranial fossa approach

Purpose of review To review the current literature on the extended middle cranial fossa (xMCF) approach and to provide a comprehensive description of the relevant anatomy, indications, surgical technique, results, and complications. Recent findings The xMCF approach expands the surgical exposure provided by the sMCF approach, allowing access to the internal auditory canal, cerebellopontine angle, prepontine cistern, anterior petrous apex, petrous carotid artery, Meckel's cave, cavernous sinus, mid and upper clivus, and posterior lesions approaching the jugular foramen. Preservation of serviceable hearing is possible with success rates approximating 50% in vestibular schwannoma and meningioma resection, and facial nerve outcome is excellent. Summary The xMCF is an important approach for difficult to access lesions that additionally offers the possibility of hearing preservation. This approach is also useful for vascular lesions, auditory brainstem implantation, and lesions of mid-brainstem. Correspondence to Ravi N. Samy, MD, FACS, Chief, Division of Otology/Neurotology, Program Director, Neurotology Fellowship, Department of Otolaryngology – Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; Neurosensory Disorders Center, University of Cincinnati Neuroscience Institute, 213 Albert Sabin Way, MSB 6407, Cincinnati, OH 45267-0528, USA. Tel: +1 513 558 1273; fax: +1 513 558 5203; e-mail: Ravi.Samy@UC.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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