Revising the Indications of Transtemporal Surgical Approaches in the Modern Endoscopic Era of Skull Base Surgery: A Dying Art.

Objectives  The aim of the study is to emphasize and explore the possible transtemporal approaches for spectrum of complicated lateral skull base pathologies. Design  Retrospective analysis of complicated lateral skull base pathologies was managed in our institute between January 2017 and December 2019. Setting  The study was conducted in a tertiary care referral center. Main Outcome Measures  The study focused on the selection of approach based on site and extent of the pathology, the surgical nuances for each approach, and the associated complications. Results  A total of 10 different pathologies of the lateral skull base were managed by different transtemporal approaches. The most common complication encountered was facial nerve palsy (43%, n  = 6). Other complications included cerebrospinal fluid (CSF) collection (15%, n  = 2), cosmetic deformity (24%, n  = 4), petrous internal carotid artery injury (7%, n  = 1), and hypoglossal nerve palsy (7%, n  = 1). The cosmetic deformity included flap necrosis ( n  = 2) and postoperative bony defects leading to contour defects of the scalp ( n  = 2). Conclusion  Surgical approach should be tailored based on the individual basis, to obtain adequate exposure and complete excision. Selection of appropriate surgical approach should also be based on the training and preference of the operating surgeon. Whenever necessary, combined surgical approaches facilitating full tumor exposure are recommended so that complete tumor excision is feasible. This requires a multidisciplinary team comprising neurosurgeons, neuro-otologist, neuroanesthetist, and plastic surgeons. The surgeon must know precise microsurgical anatomy to preserve the adjacent nerves and vessels, which is necessary for better surgical outcomes. Thieme. All rights reserved.