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Transtemporal approaches to the skull base.

Transtemporal approaches to lesions of the posterior fossa and/or temporal bone afford direct access with minimal manipulation of the subdural spaces. In most instances, the primary concern is the preservation of seventh nerve integrity or restoration of seventh nerve function in the event of loss of facial nerve integrity. The transtemporal approaches afford the surgeon the ability to trace the seventh nerve from normal to diseased regions and so increased the possibility of anatomical preservation. In addition, the availability of the seventh nerve for transposition or rerouting makes nerve grafting easier in the event of seventh nerve sacrifice. Limitation of the craniectomy site within the temporal bone without violating the deep cervical musculature avoids the complication of severe postoperative headaches so frequently seen in suboccipital resections. Thorough knowledge of the temporal bone anatomy and intracranial structures is mandatory prior to utilization of this procedure.