Abstract
Access to the cerebellopontine angle and petrous apex can challenge the most discerning skull base surgeon. Modern skull base surgery has evolved owing to advances in monitoring, instrumentation, and higher-resolution microscopy. This evolution is now accompanied by a greater expectation to preserve functional neurovascular and otological structures dependent on the approach and the pathology. The translabyrinthine approach has proven to be a reliable and safe option to access the internal acoustic canal and the cerebellopontine angle with sacrifice of the hearing mechanism. This article forms the foundation for further discussion regarding the transotic and transcochlear approaches to the petrous apex and beyond.
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