Infralabyrinthine approach to skull-base lesions.

New surgical techniques have extended the head and neck surgeon's domain to include various skull-base lesions. The infralabyrinthine approach incorporates these techniques and can be used to resect benign and malignant tumors involving the base of the temporal bone. Lesions of the internal carotid artery near the carotid foramen are also readily accessible. The main surgical steps in the infralabyrinthine approach include (1) mastoidectomy, (2) anterior transposition of the facial nerve, (3) neck dissection, (4) removal of the lateral tympanic bone, (5) exposure of the jugular foramen, and (6) exposure of the intratemporal carotid artery. Details of the infralabyrinthine approach are illustrated by photographs of surgical and cadaver dissections. Examples of various lesions successfully treated by this technique are presented. The important surgical anatomy of the infralabyrinthine compartment of the skull base is reviewed, with particular attention paid to the internal carotid artery, which, like the facial nerve, demands an intimate familiarity on the part of the temporal bone surgeon.