Acta Neurochirurgica

, Volume 153, Issue 6, pp 1161–1167 | Cite as

How I do it: epidural anterior petrosectomy

  • Pierre-Hugues RocheEmail author
  • Vincent F. Lubrano
  • Rémy Noudel
How I Do It



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.


Petrous bone Meningioma Skull base neoplasms Trigeminal ganglion Pons Clivus 



Cerebrospinal fluid


epidural anterior petrosectomy


geniculate ganglion


great superficial petrosal nerve


inferior petrosal sinus


internal auditory canal


superior orbital fissure


superior petrosal sinus


Conflicts of interest


Supplementary material


(MOV 8531 kb)


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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Pierre-Hugues Roche
    • 1
    Email author
  • Vincent F. Lubrano
    • 2
  • Rémy Noudel
    • 1
  1. 1.Service de Neurochirurgie, CHU Marseille Nord, APHMUniversité de la MéditerrannéeMarseille Cedex 20France
  2. 2.Service de Neurochirurgie, CHU ToulouseUniversité de Toulouse-Paul SabatierToulouseFrance

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