THE PRETEMPORAL APPROACH TO THE INTERPEDUNCULAR AND PETROCLIVAL REGIONS

A pretemporal approach to the interpeduncular and petroclival regions is described. Through a frontotemporal craniotomy based very low in th e middle fossa the temporal lobe is completely exposed. The Sylvian, c arotid, chiasmatic, and lamina terminalis cisterns are widely opened. The arachnoid fibers between the uncus and the frontal lobe, as well a s those binding the temporal lobe to the tentorial edge and to the ocu lomotor nerve are also separated. The bridging veins from the temporal pole to the spheno-parietal sinus are usually coagulated and sacrific ed allowing for posterior displacement of the temporal lobe. The appro ach combines the advantages of both the classical pterional and subtem poral approaches providing unhindered exposure of the anterior portion of the tentorial incisura in dealing with vascular and tumoural lesio ns arising at the sellar, parasellar, and interpeduncular regions, and at the superior aspect of the petroclival region.