Combined petrosal approach

Purpose of review The combined petrosal approach to the lateral skull base merges a retrolabyrinthine-presigmoid posterior fossa craniotomy with an adjacent middle fossa craniotomy, which are rendered continuous by division of the tentorium. This is a hearing-preserving approach that affords wide access to the lateral aspect of the clivus, the prepontine space, and the cerebellopontine angle. Recent findings This article details the historical development of the combined petrosal approach alongside a description. In particular, the critically relevant anatomy is reviewed, including the course of the vein of Labbé, with a view toward avoiding the known complications associated with this approach. Outcomes for application of this approach as applied for various lesions are also reviewed as portrayed by the current literature. Summary The combined petrosal approach affords wide access to the lateral skull base in the middle and posterior fossa. The approach and the lesions addressed by this approach involve delicate and sensitive anatomy. We review the evolution of this approach and highlight advancements that have allowed the combined petrosal approach to be a safe addition to the surgeon's armamentarium. Correspondence to Michael B. Gluth, MD, Section of Otolaryngology – Head & Neck Surgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, 5841 S. Maryland, MC1035/E-103, Chicago, IL 60637, USA. Tel: +1 773 702 7117; fax: +1 773 702 6809; e-mail: mgluth1@surgery.bsd.uchicago.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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