The infratemporal fossa approach for the lateral skull base

The infratemporal fossa approach provides wide access to the lateral skull base. Transposition of the facial nerve enables this structure to be removed from the field of definitive surgery with, in many cases, little or no functional sequelae. The systematic management of the major arteries and great venous channels has reduced hemorrhage to a known and controllable factor. The extended postauricular incision produces no more esthetic deficit than a standard mastoidectomy scar. Asepsis, antibiotics, and modern anesthesia have contributed to the success of these intricate and sometimes prolonged procedures. Cooperation between otoneurosurgeons and neurosurgeons had led to the development of planned staged procedures, which are essential when a skull base lesion has a large intradural extension. Attention to this principle is essential if one is to avoid the significant postoperative complications that can be produced by a sizable cerebrospinal fluid leak and persistent coughing and aspiration. Accurate preoperative assessment of tumor extension and embolization of suitable lesions by the otoneuroradiologist are prerequisites for successful surgery. Skull base lesions are rare but serious conditions. It is important that their management be confined to specialized centers to avoid the problems encountered by the occasional surgeon and to allow experience to be consolidated in these centers.