Skull base meningiomas can be removed through a narrow surgical corridor, provided that the attachment and the feeders are included in the surgical exposure. The anterior transpetrosal approach1,2 is a kind of “key hole skull base surgery” with the above concept for removal of petroclival tumors. The surgical steps are:1 epidural exposure of the dura overlying the tumor;2 coagulation of the feeders;3 decompression of the internal content;4 retraction of the tumor margin toward the attachment;5 dissection of the slackened nerves and vessels around the tumor; and6 removal of the tumor margin with the dural attachment. The indications, limitations, the surgical technique, and our surgical results are presented in this chapter.