The combined supra- and infratentorial approach for lesions of the petrous and clival regions: experience with 46 cases.

The combined supra- and infratentorial approach has been subdivided into three variations: the retrolabyrinthine technique (petrous bone resection with preservation of hearing); the translabyrinthine technique (greater petrous bone resection and sacrifice of hearing); and the transcochlear technique (maximum petrous drilling, sacrifice of hearing, and transposition of the facial nerve). These three variations maximize temporal bone drilling and therefore provide exquisite exposure of the clivus and petrous regions with minimal or no brain retraction. The superior petrosal sinus is always sacrificed and the tentorium completely cut. The sigmoid sinus can be transected or kept intact, depending on the venous drainage and the degree of exposure required. A series of 46 patients who underwent the combined approach is presented.