• Pierre-Hugues Roche, Vincent F Lubrano, and Rémy Noudel.
• Service de Neurochirurgie, CHU Marseille Nord, APHM, Université de la Méditerrannée, Chemin des Bourelly, 13915, Marseille Cedex 20, France. proche@ap-hm.fr
• Acta Neurochir (Wien). 2011 Jun 1;153(6):1161-7.

BackgroundAmong the potential approaches to access the petroclival area, epidural anterior petrosectomy (EAP) appears to be the most direct and conservative transpetrous route. In this article, we aim to detail the relevant surgical steps necessary to perform EAP in a reproducible and safe manner.MethodThe temporo-pterional bone flap is tailored to access the floor of the middle fossa and expose the foramen ovale and foramen spinosum. Elevation of the dura covering the upper surface of the petrous apex is conducted medially toward the level of the petrous ridge. Identification of the landmarks of the rhomboid fossa delineates the limits of the drilling zone (necessary for removal of the petrous apex)-beneath Meckel's cave and just anterior to the anterior margin of the internal auditory meatus. The tentorium is divided at its free edge and is followed by opening of the posterior fossa dura.ConclusionEpidural anterior petrosectomy is a conservative trans-petrous approach that offers an excellent direct surgical corridor for exposure of disease processes involving Meckel's cave, the petroclival area and the ventrolateral pons.

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