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[Opening of the carotid canal in the skull base surgery: drilling of the carotid canal triangle].

With the recent advance in skull base surgery, approaches to the cavernous sinus and frontal skull base have been established and introduced positively. The author has applied extensive transbasal approach to lesions in the frontal skull base, and transzygomatic approach to those in the middle skull base, but since the fact that the internal carotid artery runs inside the temporal bone restricts surgical procedure for lesions extending not only to the middle skull base but to the infratemporal fossa, preservation of the internal carotid artery during surgery is demanded. Radical surgery was performed for 5 patients with malignant tumor occupying the infratemporal fossa, resulting in successful en-bloc resection of the tumor by securing a substantial operative space during surgery after early opening of the carotid canal for preservation of the internal carotid artery. In opening the carotid canal, the carotid canal triangle is first identified, then its bone is shaved and cut as far as the spine of the sphenoid, allowing a look at the inside of the tumor, or a view of the internal carotid artery, that permits en-bloc resection of the tumor. Representative cases are reported here and microanatomical information for surgical procedure in opening the carotid canal is also presented with the relevant literature.