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The authors have presented a large series of patients who were treated with EAPA, focusing on complications and their avoidance.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The authors carried out a retrospective review of patients who underwent EAPA at their institution between 2012 and 2021. They collected preoperative clinical characteristics, operative reports, operative videos, findings on neuroimaging, histological diagnosis, postoperative course, and clinical status at last follow-up. For pathologies without petrous bone invasion, the amount of petrous apex drilling was calculated and classified as low (&lt; 70% of the volume) or high (\u2265 70%). Complications were dichotomized as approach related and resection related.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>This study included 49 patients: 26 with meningiomas, 10 brainstem cavernomas, 4 chondrosarcomas, 4 chordomas, 2 schwannomas, 1 epidermoid cyst, 1 cholesterol granuloma, and 1 osteoblastoma. The most common approach-related complications were temporal lobe injury (6.1% of patients), seizures (6.1%), pseudomeningocele (6.1%), hearing impairment (4.1%), and dry eye (4.1%). Approach-related complications occurred most commonly in patients with a meningioma (p = 0.02) and Meckel\u2019s cave invasion (p = 0.02). Gross-total or near-total resection was correlated with a higher rate of tumor resection\u2013related complications (p = 0.02) but not approach-related complications (p = 0.76). Inferior, lateral, and superior tumoral extension were not correlated with a higher rate of tumor resection\u2013related complications. No correlation was found between high amount of petrous bone drilling and approach- or resection-related complications.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>EAPA is a challenging approach that deals with critical neurovascular structures and demands specific skills to be safely performed. Contrary to general belief, its approach-related morbidity seems to be acceptable at dedicated skull base centers. Morbidity can be lowered with careful examination of the preoperative neuroradiological workup, appropriate patient selection, and attention to technical details.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2022.3.jns212962","type":"journal-article","created":{"date-parts":[[2022,6,20]],"date-time":"2022-06-20T18:53:15Z","timestamp":1655751195000},"page":"276-286","source":"Crossref","is-referenced-by-count":24,"title":["Surgical morbidity of the extradural anterior petrosal approach: the Lariboisi\u00e8re experience"],"prefix":"10.3171","volume":"138","author":[{"given":"Lorenzo","family":"Giammattei","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Lariboisi\u00e8re Hospital, University of Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thibault","family":"Passeri","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Lariboisi\u00e8re Hospital, University of Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosaria","family":"Abbritti","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Lariboisi\u00e8re Hospital, University of Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Lieber","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Lariboisi\u00e8re Hospital, University of Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fumihiro","family":"Matano","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Lariboisi\u00e8re Hospital, University of Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tuan Le","family":"Van","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Lariboisi\u00e8re Hospital, University of Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsushi","family":"Okano","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Lariboisi\u00e8re Hospital, University of Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arianna","family":"Fava","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Lariboisi\u00e8re Hospital, University of Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo di","family":"Russo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Lariboisi\u00e8re Hospital, University of Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00e9bastien","family":"Froelich","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Lariboisi\u00e8re Hospital, University of Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Laryngoscope","doi-asserted-by":"publisher","first-page":"1363","DOI":"10.1288\/00005537-196111000-00004","article-title":"Surgical exposure of the internal auditory canal and its contents through the middle, cranial fossa","volume":"71","author":"House WF","year":"1961","unstructured":"House WF. 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