Anterior transpetrosal approach for petroclival tumors

The petroclival or prepontine tumors originating medial to the trigeminal nerve include meningiomas, trigeminal neurinomas, laterally extended chordomas and prepontine epidermoids. They frequently show middle fossa or parasellar extension and have been one of the difficult tumors requiring a combined large craniotomy or multiple step surgery. Here, we will present a surgical method of tumor removal through a keyhole, epidurally created in a petrous apex. The technical points presented are based on my experience of 95 cases. This approach has the following advantages: (1) One-stage epidural surgery to the petroclival and dumbbell parasellar–clival lesions through a small craniotomy;(2) Minimal venous complications compared to the presigmoid approach;(3) Minimal facial and lower cranial nerves injury by jumping into the petroclival area medial to the internal auditory meatus;(4) Bloodless tumor removal being possible by detachment of the tentorial artery;(5) Hearing preservation by limited petrous resection.