The zygomaticotemporal approach with medial petrosectomy offers an alternat
ive exposure for intradural lesions anterior to the brain stem. It improves
access for tumours of the clivus and facilitates proximal control in low l
ying and giant basilar artery aneurysms. Twenty-three patients were operate
d on using this approach (12 aneurysms of the posterior circulation and 11
tumours). The permanent complications experienced with this exposure were i
psilateral hearing loss (two cases) and facial nerve palsy (one case). The
experience in this series shows it is a useful alternative in accessing thi
s difficult area.