An extended middle fossa approach combined with a suboccipital craniectomy to the base of the skull in the posterior fossa.

A new approach to the base of the skull in the posterior fossa is described. This approach involves removing the petrous bone without any injury to the labyrinth, and dividing the superior petrosal sinus and tentorium cerebelli. A combined suboccipital craniectomy is used for excision of the portion of tumors that extended inferiorly. Total or subtotal removal of tumors was performed in 11 patients and partial removal in 3 patients, without any operative mortality. The facial nerve was preserved in all patients and hearing was retained in 9 of 12 patients. This approach is useful for large tumors located around the clivus.