• Claudio H F Vidal, Joab A Nicácio, Yoav Hahn, Caldas NetoSilvio SSSDepartment of Otolaryngology, Health Science Center, Universidade Federal de Pernambuco, Recife, Brazil., and Caetano J Coimbra.
• Department of Neurosurgery, Getúlio Vargas Hospital, Recife, Brazil.
• Oper Neurosurg (Hagerstown). 2020 Oct 15; 19 (5): 589-598.

BackgroundTranspetrosal approaches have been used for treatment of tumors in the petroclival region for many years. Injury to the temporal lobe, however, has been a potential drawback of the techniques described to date.ObjectiveTo describe modifications of the transpetrosal surgical technique, which allows extradural manipulation of the temporal lobe during the focused combined transpetrosal approach. This extra layer of protection avoids mechanical brain retraction, direct trauma to the temporal lobe and disruption of the local venous structures.MethodsThe present manuscript describes an innovative technical nuance based on the combination of the focused combined transpetrosal approach, the peeling of the dural layers of the tentorium, and the reverse peeling of the middle fossa dura mater. Ample illustrative material is provided and illustrative cases are presented.ConclusionPeeling of the dural layers of the tentorium is a promising modification of the transpetrosal approach to increase the safety of the temporal lobe manipulation.Copyright © 2020 by the Congress of Neurological Surgeons.

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