OBJECTIVE: To discuss the operative technique, advantage and postoperative complications in 41 patients with giant petroclival tumors treated with the supra- and infratentorial transpetrousal presigmoid approach. METHODS: Clinical data were obtained from the review of charts and radiographic images of the 41 patients after operation with temporo-occipotal free osseous flap, partial petrosectomy and mastoidectomy were performed around the labyrinth. The semicircular canals, cochlea and tympanic cavity were protected during the operation. After the super petrous was ligated and cut off, the petroclival region in front of the sigmoid sinus was exposed. RESULTS: In the 41 patients 20 had meningiomas, 20 epidermoid cysts, and one schwannoma. Total resection was performed in 34 patients, subtotal resection in 16, and greater partial resection in one. Major postoperative complications included temporal aphasia (10 patients), cerebral edema (6), brain stem infarct (2), IIIth, VIIth, VIth and posterial group cranial nerves palsies (16, 16, 8, 6 respectively), and cerebrospinal fluid leakage (4 cases). CONCLUSIONS: This approach can expose sufficiently the petroclival region. It can also reveal the area of adjacent sella, interpeduncular and formen magnum, and homolateral III-XIIth cranial nerves. The postoperative complications may be related to operative techniues and tumorous characteristics.