Anterior transpetrosal approach

The Anterior Transpetrosal Approach

Point

・中頭蓋窩底の膜構造を組織学的に理解し，大錐体神経を温存した硬膜外剝離によって錐体骨先端部を露出する．

・錐体骨先端部の削除は，正確な解剖学的知識に基づき，後頭蓋窩の硬膜を確認してから斜台の方向へ向かうと効率がよい．

・テント切開においては滑車神経，三叉神経，上錐体静脈に注意するが，特に腫瘍の場合は正常解剖が偏移していることを念頭に置く．

　The Anterior transpetrosal approach is a skull base surgical procedure that can provide a wide operative view of the petroclival and the prepontine region. This approach requires one to accurately understand the anatomy of the anterior part of the temporal bone and the histological structure of the dura mater. In addition, it is necessary to learn operative techniques for venous preservation, accurate hemostasis at each step, and prevention of cerebrospinal fluid leakage. In this article, the anatomy and surgical techniques that are required for a beginner to master the anterior transpetrosal approach are explained step by step.