Dural incision in the petrosal approach with preservation of the superior petrosal vein.

The petrosal approach has been applied for the treatment of many lesions in the posterior fossa, but the location and preservation of the superior petrosal veins (SPVs) during this approach are usually not particularly considered. The authors developed a technique of dural incision with special consideration of the location of the SPVto preserve venous flow during the petrosal approach. The authors describe technical details on how to cut the dura mater and superior petrosal sinus, with special attention to the location of SPV, so that the normal flow of the SPV to the lateral sinus can be preserved. Between July 2007 and March 2014, this technique was used in 45 patients, and no major complications were reported. The SPVs should be considered critical structures in the petrosal approach. Preoperative evaluation of the SPV anatomy should be performed in patients undergoing such surgical treatment, and the dural opening must be performed with special attention to the SPVto avoid intraoperative injury and postoperative complications.