title: How I do it: epidural anterior petrosectomy.
abstract: BACKGROUND
  Among 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.
  
  
  METHODS
  The 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.
  
  
  CONCLUSIONS
  Epidural 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.
authors.affiliation: Service de Neurochirurgie, CHU Marseille Nord, APHM, Université de la Méditerrannée, Chemin des Bourelly, 13915, Marseille Cedex 20, France. proche@ap-hm.fr
authors.forename: Pierre-Hugues
authors.initials: PH
authors.lastname: Roche
authors.forename: Vincent F
authors.initials: VF
authors.lastname: Lubrano
authors.forename: Rémy
authors.initials: R
authors.lastname: Noudel
mesh_terms: D002813:Chondrosarcoma / Q000601:surgery; D002817:Chordoma / Q000601:surgery; D035301:Cranial Fossa, Middle / Q000601:surgery*; D003388:Cranial Fossa, Posterior / Q000601:surgery*; D003390:Cranial Nerve Neoplasms / Q000601:surgery; D003399:Craniotomy / Q000379:methods*; D003884:Dermoid Cyst / Q000601:surgery; D004814:Epidermal Cyst / Q000601:surgery; D054085:Foramen Ovale / Q000601:surgery; D020786:Hemangioma, Cavernous, Central Nervous System / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008577:Meningeal Neoplasms / Q000601:surgery; D008579:Meningioma / Q000601:surgery; D009442:Neurilemmoma / Q000601:surgery; D010579:Petrous Bone / Q000601:surgery*; D011149:Pons / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis; D019292:Skull Base Neoplasms / Q000601:surgery; D020433:Trigeminal Nerve Diseases / Q000601:surgery