Combined transpetrosal-subtemporal craniotomy for clival tumors with extension into the posterior fossa.

Tumors of the clivus, such as chordoma and chondrosarcoma, are generally amenable to an anterior surgical approach. However, approaches that traverse the pharynx or paranasal sinuses do not adequately expose tumor posterolateral to the horizontal course of the intrapetrous carotid artery. In addition, when tumor extends into the posterior fossa, supplemental exposure of neurovascular structures is necessary. A combination petrosectomy and subtemporal craniotomy can provide simultaneous access to the entire clivus as well as the lateral aspect of the midbrain, pons, and upper medulla. The extent of petrosectomy performed depends on a number of factors including status of hearing, facial nerve function, and degree of brainstem compression. In our experience with three patients (two chordomas and one chondrosarcoma), using either the retrolabyrinthine-subtemporal or transcochlear-subtemporal approach, excellent resection was achieved with acceptable morbidity considering the extensive nature of the disease.