The infratemporal fossa approach to skull base surgery.

The infratemporal fossa approach, in conjunction with the application of microsurgical technique and improved perioperative care, has permitted significant advances in lateral skull base surgery. The glomus jugulare tumor is the prototypical neoplasm resected by this approach, although this technique can be applied to a host of additional benign and malignant lesions of the skull base. This approach entails identification and control of the cranial nerves and great vessels in the neck, anterior transposition of the facial nerve, and infralabyrinthine petrosectomy. Intracranial tumor extension and petrous carotid artery involvement remain limiting factors. Significant morbidity, particularly neurologic deficit and hemorrhage, may occur due tot the nature and location of lateral skull base tumors. Recent advances in preoperative embolization and temporary carotid artery balloon occlusion have advanced the limits of resection via the infratemporal fossa approach.