title: How I do it: the combined petrosectomy.
abstract: BACKGROUND
  Petroclival and ventral brain stem tumors require a complex approach.
  
  
  METHODS
  The combined petrosectomy is an epidural transtentorial-transpetrosal otoneurosurgical approach to achieve a retrolabyrinthine presigmoidal approach and an anterior petrosectomy in one single procedure. The different steps of this approach are described and illustrated by figures and a video. The indications and limitations of the technique are presented.
  
  
  CONCLUSIONS
  The combined petrosectomy offers multiple corridors to the petroclival region and ventral brainstem while preserving the intrapetrous neurotological structures. Meticulous stepwise bony resection optimizing the dural opening and preservation of veins contributes to reducing the risk inherent to this technique.
authors.affiliation: Department of Neurosurgery, North University Hospital, APHM, Marseille, 13015, France. lucas.troude@hotmail.fr.
authors.forename: Lucas
authors.initials: L
authors.lastname: Troude
authors.affiliation: Department of Neurosurgery, North University Hospital, APHM, Marseille, 13015, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Carissimi
authors.affiliation: Department of Neurosurgery, North University Hospital, APHM, Marseille, 13015, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Lavieille
authors.affiliation: Department of Neurosurgery, North University Hospital, APHM, Marseille, 13015, France.
authors.forename: Pierre-Hugues
authors.initials: PH
authors.lastname: Roche
mesh_terms: D006801:Humans; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D010579:Petrous Bone / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000601:surgery*
keywords: Combined petrosectomy; Petroclival region; Petrous bone; Presigmoid approach; Skull base meningioma; Skull base surgery