The anterior transpetrous approach (ATA) according to Kawase applying the resection of the anterior part of the pyramid enables a surgical view via the middle cranial fossa from the parasellar area into the upper petroclival area and prepontine cistern. The indications for its utilization are lesions anterior of the internal auditory meatus and medial of the trigeminal nerve together with dumbbell-shaped tumors reaching both the middle and posterior cranial fossae. The main advantage of ATA is the preservation of hearing and, in the case of meningeomas, early devascularization of tentorial arteries. The authors have presented surgical technique, examples of application, and results of the anterior transpetrous approaches. This surgical method is compared with classical retrosigmoideal trajectory (RISA). ATA is more suitable in tumors with the sandglass-like extension and in those with supposed radical removal. On the contrary, RISA is more advantageous in tumors whose larger part is situated within the posterior fossa, in those without extension into the cavernous sinus, and in risk patients where the principal aim is a simple decompression of the brain stem.

        Key words: surgery of the cranial base, petroclival tumor, anterior transpetrous approach (ATA), retrosigmoideal intradural suprameatal approach (RISA)