Lesions in the extradural middle and upper clival region, including the posterior cavernous sinus, and those in the infratemporal and middle fossa areas can be accessed by the subtemporal preauricular infratemporal approach. This method requires drilling of the petrous bone and clivus, and mobilization of the petrous internal carotid artery. The anatomy of the petrous apex and middle cranial fossa is complex, and thorough knowledge of the anatomic landmarks in this area is necessary in order to explore the petrous internal carotid artery with minimal risk.