• Pakrit Jittapiromsak, Hakan Sabuncuoglu, Pushpa Deshmukh, Peter Nakaji, Robert F Spetzler, and Mark C Preul.
• Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
• Neurosurgery. 2009 May 1;64(5 Suppl 2):253-8; discussion 258-9.

ObjectiveTo introduce a novel surgical technique for the dissection of the greater superficial petrosal nerve (GSPN) in the middle fossa approach.MethodsInterdural temporal elevation was performed with a front-to-back technique to preserve the GSPN in 12 sides of 6 injected cadaveric heads dissected through a middle fossa approach.ResultsThe GSPN emerged from the facial hiatus in a shallow bony groove proximally, ran into a deeper sphenopetrosal groove, and eventually reached the mandibular nerve. With front-to-back dissection, this nerve was easily identified at the posterior border of the mandibular nerve. Dissection from front to back minimized the retraction force applied to the proximal part of the GSPN, which was preserved in all specimens.ConclusionThe temporal dura can be elevated safely with a front-to-back technique to preserve the GSPN and to help maintain the physiological integrity of the facial nerve.

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