Combined Petrosectomy in a 7-Year-Old Patient: Case-Based Video Illustration and Technical Considerations for Petrosal Approaches in the Pediatric Population

BACKGROUND AND IMPORTANCE: Combined petrosectomy is a well-established technique in adult skull base surgery, offering wide exposure and enabling complete resection of complex lesions. In pediatric patients, its use remains uncommon because of the lower incidence of skull base tumors and age-dependent anatomic limitations, particularly in the developing temporal bone. We present a case of combined petrosectomy in a 7-year-old child and review the developmental anatomy relevant to its feasibility in children. CLINICAL PRESENTATION: A 7-year-old girl presented with progressive gait imbalance, dysarthria, and cranial nerve deficits. MRI revealed a large petroclival dermoid cyst causing brainstem compression. A mini-combined petrosectomy was performed, achieving gross total resection including the capsule with no complications. Postoperative recovery was uneventful. CONCLUSION: This case demonstrates that combined petrosectomy can be performed safely and effectively in selected pediatric patients once age-related anatomic conditions approach those seen in adults, as confirmed by preoperative imaging. These anatomic changes directly influence the feasibility and safety of combined petrosectomy in children.