[Endoscopic Anterior Transpetrosal Approach]

The anterior transpetrosal approach (ATPA) is the standard technique for treating lesions around the petrous apex. Conventional microscopic ATPA is associated with limited linear visibility and enhanced risks related to temporal lobe retraction. This article reviewed endoscopic ATPA (eATPA) and addressed some of the limitations. The eATPA utilizes a panoramic endoscopic view through a small craniotomy, significantly reducing the need for brain retraction and eliminating blind spots in the ventral brainstem. The procedure centers on precise extradural drilling of Kawase's triangle. The primary indications include small petroclival meningiomas, dumbbell-shaped trigeminal schwannomas, and epidermoid cysts. This review detailed the surgical anatomy, operative nuances, and strategies for avoiding critical complications, specifically venous congestion, regarding the superficial middle cerebral vein, superior petrosal vein, and cerebrospinal fluid leakage. Although currently indicated for small lesions, eATPA is a minimally invasive skull base surgery. eATPA is a vital component of future multicorridor strategies, offering safer, tailor-made treatments for complex skull base pathologies when combined with endovascular or transnasal approaches.