Skip to main content

How I do it: combined petrosectomy



Petroclival lesions are among the most complex to address in skull base surgery, being closely related to critical neurovascular structures and brainstem. The combined petrosectomy allows a wide exposure of large petroclival lesions with short working distance and provides multiple angles of attack, while limiting brain retraction.


We describe in a step-wise fashion the surgical steps of the combined petrosectomy.


Combined petrosectomy with posterior transposition of the transverse-sigmoid sinus provides a wide surgical corridor to the ventral brainstem, middle and upper clivus, and infra-retrochiasmatic region.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5


  1. 1.

    Al-Mefty O, Fox JL, Smith RR (1988) Petrosal approach for petroclival meningiomas. Neurosurgery 22:510–517

    CAS  Article  Google Scholar 

  2. 2.

    Hakuba A, Nishimura S, Jang BJ (1988) A combined retroauricular and preauricular transpetrosal-transtentorial approach to clivus meningiomas. Surg Neurol 30:108–116

    CAS  Article  Google Scholar 

  3. 3.

    Haq IB, Susilo RI, Goto T, Ohata K (2016) Dural incision in the petrosal approach with preservation of the superior petrosal vein. J Neurosurg 124:1074–1078

    Article  Google Scholar 

  4. 4.

    Troude L Jr, Carissimi M Jr, Lavieille JP, Roche PH (2016) How I do it: the combined petrosectomy. Acta Neurochir 158:711–715

    Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Sébastien Froelich.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Patient consent

The patient has consented to the submission of this How I Do It for submission to the journal.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Neurosurgery general

Electronic supplementary material

Operative video demonstrating the major steps described in this work to perform the combined petrosectomy (MOV 269654 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Hanakita, S., Watanabe, K., Champagne, PO. et al. How I do it: combined petrosectomy. Acta Neurochir 161, 2343–2347 (2019).

Download citation


  • Anterior petrosectomy
  • Combined petrosectomy
  • Petroclival region
  • Posterior petrosectomy
  • Skull base surgery