• Keaton Piper, Ivo Peto, Victoria Qizhi Tay, Alex Tai, Christopher Danner, K Paul Boyev, Harry Van Loveren, and Siviero Agazzi.
• Department of Neurosurgery, University of South Florida, Tampa, Florida, USA.
• World Neurosurg. 2023 Jul 1; 175: e428e433e428-e433.

Background And ObjectiveThe combined petrosectomy is one of the workhorse skull base approaches to the petroclival region. Traditionally, this approach starts with a temporosuboccipital craniotomy, followed by the mastoidectomy/anterior petrosectomy, and completed with the dural opening/tumor resection. This sequence of events (neurosurgery-neuro-otology-neurosurgery) involves at least 2 handoffs and change of surgical teams and instrumentation. This report describes a resequencing of events and a modification of the technique used to craft the temporosuboccipital craniotomy, with aims to reducing handoffs between surgical teams and improving operating room workflow.MethodsAdhering to PROCESS guidelines, a case series is provided in addition to the surgical technique and surgical images.ResultsThe technique for performing a combined petrosectomy is described with illustrations. This description shows that the temporal bone drilling may be performed before the craniotomy to allow for direct visualization of the dura and sinuses before completing the craniotomy. In doing so, only 1 transition between the otolaryngologist and neurosurgeon is necessary, thereby improving operating room workflow and time management. A series of 10 patients is presented, showing the feasibility of this procedure and providing operative details that were previously absent in the peer-reviewed literature.ConclusionsCombined petrosectomy, although often performed in a 3-step manner with the neurosurgeon starting the craniotomy, can be performed as described here in a 2-step manner, with similar outcomes and reasonable operating time.Copyright © 2023 Elsevier Inc. All rights reserved.

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