How I do it: epidural anterior petrosectomy

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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.


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.


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.

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Cerebrospinal fluid


epidural anterior petrosectomy


geniculate ganglion


great superficial petrosal nerve


inferior petrosal sinus


internal auditory canal


superior orbital fissure


superior petrosal sinus


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Correspondence to Pierre-Hugues Roche.

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Roche, P., Lubrano, V.F. & Noudel, R. How I do it: epidural anterior petrosectomy. Acta Neurochir 153, 1161–1167 (2011).

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  • Petrous bone
  • Meningioma
  • Skull base neoplasms
  • Trigeminal ganglion
  • Pons
  • Clivus