Chapter 14 - Combined Retrosigmoid and Limited Anterior Petrosectomy (“Reverse Petrosectomy”)

Summary

Traditionally, lesions communicating between the middle fossa or supratentorial cisterns and the posterior fossa have been addressed by middle fossa approaches with the addition of a traditional anterior petrosectomy, or alternatively presigmoid approaches incorporating a posterior petrosectomy. Alternatively, when global access is needed a combined petrosal approach may be used. These approaches have advantages and disadvantages that those using them frequently are well acquainted with, and will be covered elsewhere in this book. However, a less utilized approach that takes full advantage of the familiarity and relative ease of a retrosigmoid operation is the addition of a suprameatal boney removal (we euphemistically call this the reverse petrosectomy) in select cases, which minimizes approach-related morbidity and dissection. Further, an endoscope can be used to augment visualization previously accomplished with boney removal necessitated by the straight line of sight inherent to the microscope. Here we describe this technique in detail, taking advantage of a component-based approach to the skull base.