AbstractWe reviewed our experience with combined approaches to lesions that transcend the bones of the skull base. Seventy‐seven skull base procedures were performed on 73 patients during a 10‐year period from 1982 to 1992. There were 34 patients (44%) with region I lesions (anterior), seven patients (9%) with region II lesions (anterior‐lateral), 25 patients (32%) with region III lesions (lateral‐posterior), and 11 patients (14%) with lesions that invaded more than one anatomic site. The histopathology in this series was quite variable, with 22 patients (29%) having squamous cell carcinoma and eight patients (10%) having basal cell carcinoma. Forty‐one patients had surgery by an anterior approach and 38 patients had lateral approaches, with 18 undergoing an infratemporal approach and 29 undergoing temporal bone resections. Overall, 44% of the patients had a postoperative complication. Survival of this heterogeneous group of patients is 79% at 2 years and 71% at 4 years, with those patients with region II disease having a statistically significant poorer prognosis with no survivors at 4 years. © 1994 John Wiley