Increasing exposure of the petrous internal carotid artery for revascularization using the transzygomatic extended middle fossa approach: a cadaveric morphometric study

When internal carotid artery (ICA) sacrifice is planned in the management of difficult tumors or aneurysms at the cranial base, the petrous ICA may be a useful site for anastomosis for interpositional vascular bypass. However, exposure of the artery and performing an anastomosis in this region may be technically challenging because of the narrow working corridor. The authors describe a transzygomatic extended middle fossa approach that maximizes the exposure of the petrous ICA for performing the difficult anastomosis.