Greater superficial petrosal nerve dissection: back to front or front to back?

Overview

OBJECTIVE: To introduce a novel surgical technique for the dissection of the greater superficial petrosal nerve (GSPN) in the middle fossa approach. METHODS: Interdural 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. RESULTS: The 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. CONCLUSION: The 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.