title: The combined subtemporal-suboccipital approach: a modified surgical access to the clivus and petrous apex.
abstract: OBJECTIVE
  The surgical access to the clivus and the petrous apex is still a challenge. A combined approach is best fitted to lesions located in the middle and posterior cranial fossa. The approach described is centered on the petrous bone and requires an extensive bone resection; nevertheless, no osteoplastic bone flap is necessary.
  
  
  METHODS
  In contrast to approaches described before, the petrous bone is drilled away anterior to the sigmoid sinus more extensively, the sinus is unroofed. For exposure of the middle cranial fossa the petrous bone should be resected down to the roof of the external meatus, the total extent of the craniotomy is significantly smaller.
  
  
  CONCLUSIONS
  The surgical access as described above provides a wide operative field under preservation of important intracranial structures. This modified approach minimizes the cerebellar and temporal lobe retraction. The neural and vascular structures can be preserved under direct vision to the tumor. The blood supply is interrupted at the beginning of the operation.
authors.affiliation: Neurosurgical Department, University of Lübeck, Germany. Sepehrni@medinf.mu-luebeck.de
authors.forename: A
authors.initials: A
authors.lastname: Sepehrnia
authors.forename: U
authors.initials: U
authors.lastname: Knopp
mesh_terms: D003388:Cranial Fossa, Posterior / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic; D009422:Nervous System Diseases / Q000175:diagnosis / Q000601:surgery; D010579:Petrous Bone / Q000601:surgery*; D011446:Prospective Studies; D019291:Skull Base / Q000601:surgery*; D016896:Treatment Outcome