The pretemporal approach has been previously described in the literature for the management of skull base tumors or vascular pathologies involving the middle fossa, cavernous sinus and paraclinoid areas. We fully describe the operative technique to perform the epidural pretemporal approach, initially in cadaveric specimens describing the anatomy and the surgical corridors which may be accesible. We used 5 cadaveric specimens and photographed the approach. A pterional incision was done followed by a 3 burr hole craneotomy. A epidural dissection of the frontal and temporal lobes was completed. The sphenoidal lesser wing was exposed and drilled until the periorbit was unrooofed. The lateral orbital fissure was opened and the foramen rotundum is seen laterally. A peeling of the middle fossa is done while preserving a dissection layer with the cavernous sinus. This peeling is continued posteriorly exposing V3, foramen spinosum, GSPN and finally the petrous apex. The diversity of the surgical routes which can be gradually aquired with this approach are following; the orbit, planum sphenoidale, tubercullum sellae, paraclinoidal and suprasellar region, cavernous sinus, transcavernous sinus, trans Meckel´s cave, trans anterior petrosal, infratemporal fossa, sphenoid sinus and pterigopataline fossa. Later, a series of cases, including vascular and tumoral pathologies, are included describing them with pre trans and postoperative pictures and videos which show the advantages of this approach. This series includes 9 (20%) paraclinoid aneurysms, 1 (2%) sphenoid sinus pseudoaneurysm, 14 (31%) cavernous sinus tumors, 11 (24%) petroclival region tumors, 10 (22%) infratemporal fossa tumors. Conclusion: The diversity of surgical corridors and the pathologies which can be treated makes this approach very usefull in treating skull base lesions and since it is the centerpiece of the surgical field, it requires an adecuate management in and out the cavernous sinus.