Craniotomy Procedures

The anterior petrosal, or Kawase, approach is an extradural skull base route to the upper clivus, petroclival region, and anterolateral brainstem. It involves a temporal craniotomy, middle fossa dural elevation, and drilling of the petrous apex within Kawase’s triangle. This approach provides a short, direct surgical corridor while limiting brain retraction and improving exposure of deep neurovascular structures.

The posterior transpetrosal approaches, including the perilabyrinthine, translabyrinthine, and transcochlear approaches, provide direct and wide exposure of the cerebellopontine angle and posterior petroclival region. The translabyrinthine approach is commonly used for the removal of acoustic neuromas and other lesions of the cerebellopontine angle.