How I do it: combined petrosectomy.

Abstract

Petroclival lesions are among the most complex to address in skull base surgery, being closely related to critical neurovascular structures and brainstem. The combined petrosectomy allows a wide exposure of large petroclival lesions with short working distance and provides multiple angles of attack, while limiting brain retraction. We describe in a step-wise fashion the surgical steps of the combined petrosectomy. Combined petrosectomy with posterior transposition of the transverse-sigmoid sinus provides a wide surgical corridor to the ventral brainstem, middle and upper clivus, and infra-retrochiasmatic region.