In recent years, lateral skull base surgery has developed rapidly, and Fisch’s inferior temporal fossa approach is the most famous, which laid the foundation of lateral skull base surgery. On the basis of the infratemporal fossa approach, scholars of various specialties have further improved it and formed a series of new skull base approaches, such as the infratemporal-preauricular infratemporal fossa approach, the middle cranial fossa-inferior temporal fossa approach, the orbitozygomatic-inferior temporal fossa approach, etc., in order to adapt to the surgical exposure needs of different skull base areas, and achieved Good results were achieved. Huang Anyang, Department of Neurosurgery, National Hospital of Guangxi Zhuang Autonomous Region 1 Concept and division of lateral skull base An extension line is made below the skull base along the infraorbital fissure and the occipital fissure, and the intersection angle of the two lines is about 90°, and the intersection angle is inward at the nasopharyngeal roof, and the area between the two lines is defined as the range of the lateral skull base. The lateral skull base can be divided into 6 subdivisions: (1) nasopharyngeal area; (2) eustachian tube area; (3) neurovascular area: 4 skull base orifices consisting of the external opening of the internal carotid artery canal, jugular vein foramen, subglottic nerve foramen and stem mammary foramen. The external opening of the internal carotid artery canal has the internal carotid artery and the sympathetic fibers of the internal carotid artery from the superior cervical ganglion passing through it. The jugular foramen has the internal jugular vein and the Ⅸth, Xth, and D. cerebral nerves passing through it; the inferior lingual nerve foramen passes through the eponymous nerve; and the facial nerve exits the stem mammary foramen at the base of the temporal bone; (4) the auditory area; (5) the articular area; and (6) the inferior temporal fossa area. 2 Staging of inferior temporal fossa approach Lateral skull base tumors mainly include jugular vein bullae, slope chordoma, meningioma, nerve sheath tumor, parotid deep lobe tumor and nasopharyngeal fibrovascular tumor. The tumors may invade several subdivisions of the lateral skull base or extend intracranially. If neurovascular areas are involved, a more appropriate surgical approach is necessary to expose and protect the internal carotid artery, control bleeding from the internal jugular vein and dural sinus, and preserve the function of the facial and other cerebral nerves. In this regard, the inferior temporal fossa approach reported by Fisch in 1978 can widely expose the neurovascular area and other areas of the lateral skull base, and is an ideal approach for large jugular vein bullae and inferior temporal fossa tumor removal. The inferior temporal fossa approach can be divided into three types according to the extent of exposure: (1) type A: access to the inferior vagus area and the tip of the rock; (2) type B: access to the slope and nasopharynx; and (3) type C: access to the parsaddle and pars pterygoid. The recently proposed inferior temporal fossa approach, type D, is suitable for nasopharyngeal fibrovascular tumor grade II and grade IIIa, i.e., the tumor is still confined to the inferior temporal fossa or pterygopalatine fossa and does not invade the internal carotid artery. 3 Principles of lateral skull base surgery The development of lateral skull base surgery is largely attributed to Fisch, who described the keys to successful lateral skull base surgery as (1) microscopic operation, (2) adequate removal of skull base bone with minimal lifting of brain tissue, (3) keeping the operation outside the dura as much as possible, and (4) occlusion of the middle ear cavity to prevent postoperative subarachnoid infection.