Extradural anterior transpetrosal approach: how I do it.

BACKGROUND

Petroclival and brainstem lesions remain challenging to access due to their deep-seated location and proximity to critical neurovascular structures.

METHOD: We describe the step-by-step technique of the standard extradural anterior transpetrosal approach, and its extensions, illustrated through cadaveric and surgical illustrations. A surgical video demonstrates its application in a patient with a petroclival meningioma with posterolateral extension.

CONCLUSION

The extradural anterior transpetrosal approach provides a direct « looking-down» trajectory to petroclival lesions with minimal brain retraction, making it a valuable route for safe and effective access to this complex anatomical region.