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Middle Fossa Approach Following Petrous Drilling

Surgical Correlation

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Right lateral view looking down on the pons and cerebellum following skull bone resection, reflection of the temporal lobe, reflection of the tentorium cerebelli, and partial resection of the petrous bone. From this perspective, the trigeminal nerve can be seen arising from the pons, and the oculomotor and trochlear nerves from the ventral and dorsal aspects of the midbrain, respectively. The greater superficial petrosal nerve is shown emerging through a hiatus in the petrous bone to reach the middle cranial fossa. It courses deep to the trigeminal nerve towards the foramen lacerum where it is joined by the deep petrosal nerve (a branch from the internal carotid sympathetic nerve plexus) to form the nerve of the pterygoid canal or Vidian nerve. (Image courtesy of AL Rhoton, Jr.)

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