Extended Exposure of the Petroclival Junction: The Combined Anterior Transpetrosal and Subtemporal/Transcavernous Approach

Introduction: The combined anterior transpetrosal and subtemporal/transcavernous approach to the petroclival junction is a demanding technique, which provides a wide exposure of the area. In this manuscript, we provide technical instructions with anatomical consideration of important landmarks and a literature review of the clinical applications for this approach.

Methods: The combined approach was performed in two cadaveric specimen and relevant anatomical aspects were studied. Additionally, the authors performed a review of the literature focusing on indications, neurologic outcome, and complications associated with the technique.

Results: A combined anterior transpetrosal and subtemporal/transcavernous approach offers a wide exposure of the crus cerebrum, pons, basal temporal lobe, cranial nerves III to VII/VIII, PCA, SCA, BA, AICA, and PComA. It has been successfully applied with acceptable morbidity and mortality rates, mainly for petroclival meningiomas.

Conclusion: The combined approach studied is a useful skull base approach to the petroclival junction and can be applied to treat large or complex pathologies such as spheno petroclival meningiomas, chordomas, or chondrosarcomas. Detailed anatomical knowledge is essential.