Combined Supra- and Infra-Tentorial Retro-Labyrinthine Pre-sigmoid Approach

This chapter describes the background, indications and key aspects of the combined supra- and infra-tentorial retro-labyrinthine pre-sigmoid approach. This approach is most commonly used for petrous apex meningiomata and vascular pathologies of the mid and upper basilar trunk. Our pre-operative evaluation includes MRI, CT to assess pneumatisation of the petrous bone and vascular imaging where necessary. Audiology and ophthalmology baseline assessments are performed if appropriate. The nuances of the operative technique are discussed with an emphasis on avoidance of complications.