Intraspinosum middle meningeal artery ligation: A simple technique to control bleeding in the middle fossa during the anterior transpetrosal approach

Shunsuke Shibao, Hamid Borghei-Razavi, Kazunari Yoshida

Research output: Contribution to journalArticle


BACKGROUND: Although the greater superficial petrosal nerve (GSPN) is an important landmark of the anterior transpetrosal approach (ATPA), bleeding fromthe interdural space around the foramen spinosum (FS), the GSPN, and the foramen ovale impedes the identification of the GSPN, during epidural dissection in the ATPA. OBJECTIVE: To describe the technique of intraspinosum middle meningeal artery (MMA) ligation, which enables us to control bleeding from the interdural space. METHODS: During epidural dissection,we identified the FS and partially drilled the lateral side of the FS. Next, we cut the convergence site of the neurovascular structures such as theMMA,middlemeningeal vein, and themeningeal branch of themandibular nervewith the periosteal dura within the FS and continued dural detachment epidurally to expose the petrous apex. Bleeding control around the FS and postoperative facial nerve paresis were assessed for 96 patients treated with the ATPA. Additionally, histological study was performed around the FS using Masson's trichrome stain. RESULTS: In all cases, inwhich this techniquewas used, bleeding fromthe interdural space waswell controlled and no persistent facial nerve paresis was identified. In the histological study, we confirmed that theMMA, the middlemeningeal vein, and themeningeal branch of the mandibular nerve converged into the FS and many venous channels existed in the interdural space around the FS and the foramen ovale. CONCLUSION: Intra-FS MMA ligation is an effective method for control of bleeding from the interdural space of the middle fossa during the ATPA.

Original languageEnglish
Pages (from-to)163-171
Number of pages9
JournalOperative Neurosurgery
Issue number2
Publication statusPublished - 2017



  • Anterior transpetrosal approach
  • Facial nerve paresis
  • Foramen ovale
  • Foramen spinosum
  • Greater superficial petrosal nerve
  • Middle meningeal artery
  • Petrosal artery

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

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