Middle cranial fossa aproach is an important surgical access in skull base surgery, which allows to reach to the medial part of the temporal bone and cavernous sinus with preservation of hea¬ring. Early identification of the pathologies invading skull base led this functional surgery be performed in increasing frequency, but, as a result of the technical limitations of this approach, today it is necessary to be more cautious on idications. However this approach is narrow compared to the other lateral transtemporal routes, even if it is exten¬ded and it is suitable only for small pathologies. According to this morphometric analysis and surgical observations, anatomy of this region is found to be quite variable and is different from classical otologic approaches. For these reasons the surgeon perfor¬ming this surgery needs adequate experience in temporal bone and cadaver dissection.