CEI Medical Group
California Ear Institute
Global Hearing
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Middle Fossa Approach

Surgical Procedure

Middle Fossa Approach

Indications for Surgery

Acoustic Neuroma (Vestibular Scwannnoma), Vestibular Nerve Section, Vascular Compression, Meningioma, Skull Base Fracture, Facial Nerve Decompression, Superior Semicircular Canal Dehiscence, Skull Base Tumors, Aneurysms, Cholesterol Granulomma.



Surgical Time

1.5 – 4 hours

Hospital Admission

Yes, 2-4 days

Surgical Procedure

The approach involves and incision above the ear with elevation of the temporalis muscle. Entrance is made through the skull (a craniotomy) with elevation of the tough lining of found on the inner surface of the skull called the dura. Bone removal is performed to expose the contents of the internal auditory canal and surrounding structures. The specific problem is rectified and the approach is closed. Fat from the abdomen (approximately 1 cm x 1 cm x 1 cm is needed) is used to both fill the space where bone removal was performed and to seal the area preventing leakage of fluid surrounding the brain (called cerebrospinal fluid or CSF). The dura is released allowing it to return to normal position trapping the fat graft in place. The square of bone removed to allow access through the skull is replace and held in place with titanium plates (which allows healing and return to normal structural integrity). The temporalis muscle and skin are sutured into place.


This approach affords the highest chance of hearing preservation in appropriate cases of Acoustic Neuroma. Hearing monitoring techniques for this procedure have been developed and refined by CEI Surgeons.



California Ear Institute