Dura Incision in Petrosal Approach with Preservation of Superior Petrosal Vein: Technical Note

Background: Although the use of the petrosal approach has been widely reported, the location and preservation of the superior petrosal vein (SPV) during this approach is usually not particularly considered. Objective: To describe our technique in dura incision with special consideration to the location of SPV to preserve venous flow during the petrosal approach. Method: A step-by-step description of the technique on how to cut the duramater and superior petrosal sinus (SPS), with special attention to the location of the SPV, is offered in this report so that the normal flow of SPV to lateral sinus can be preserved. We discuss the clinical implications, advantages, and limitations of this technique. Case illustration and operative video are presented to demonstrate the technique. Result: The senior author has successfully used this technique on many petrosal approach procedures. Conclusion: The SPV should be considered as one of critical structures in the petrosal approach. To avoid intraoperative injury of SPV, the opening of the dura must be performed with special attention to the location of the SPV and its entry point to SPS. Preservation of the petrosal venous complex, especially large caliber veins, should be attempted whenever possible to increase the safety of surgery.