This article presents a series of 30 patients who underwent a combination of the subtemporal and posterior fossa approaches for exposure of lesions in the clivus or medial petrous region. This combined supra- and infratentorial approach is divided into three variations with progressively greater petrous bone resection to increase exposure of the clivus and medial petrous region. The approach has been divided into petrous bone resection with preservation of hearing (retrolabyrinthine), greater petrous bone resection with sacrifice of hearing (translabyrinthine), and finally maximum petrous drilling with sacrifice of hearing along with transposition of the facial nerve (transcochlear). Ninety-three percent of the cases returned to their premorbid occupations.
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