THE COMBINED SUPRATENTORIAL AND INFRATENTORIAL APPROACH FOR LESIONS OF THE PETROUS AND CLIVAL REGIONS - EXPERIENCE WITH 46 CASES

The combined supra- and infratentorial approach has been subdivided in to three variations: the retrolabyrinthine technique (petrous bone res ection with preservation of hearing); the translabyrinthine technique (greater petrous bone resection and sacrifice of hearing); and the tra nscochlear technique (maximum petrous drilling, sacrifice of hearing, and transposition of the facial nerve). These three variations maximiz e temporal bone drilling and therefore provide exquisite exposure of t he clivus and petrous regions with minimal or no brain retraction. The superior petrosal sinus is always sacrificed and the tentorium comple tely cut. The sigmoid sinus can be transected or kept intact, dependin g on the venous drainage and the degree of exposure required. A series of 46 patients who underwent the combined approach is presented.