Combined skull base approaches to the posterior fossa

Combined approaches to the skull base provide maximal exposure of the complex and eloquent anatomical structures contained within the posterior fossa. Common to these combined exposures are variable degrees of petrous bone removal. Understanding the advantages of each approach is critical when attempting to balance increases in operative exposure against the risk of potential complications. Despite their risks, aggressive combined exposures to the posterior fossa enable the greatest degree of visualization of the anatomy. Consequently, surgeons can approach lesions with maximal margins of safety, which cannot otherwise be realized. To minimize morbidity in all cases, the approach chosen must be applied individually, depending on the lesion and the patient's characteristics.