Extradural anterior transpetrosal approach: how I do it.

Passeri, Thibault; Heemann, Gabriel C; Grouls, Michelle; Froelich, Sébastien · Acta Neurochir (Wien) · 2026

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Abstract

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