Abstract: Objective To evaluate the surgical treatment of communicative lateral skull base diseases. Methods The common ground of 20 patients was bone defect of lateral skull base with various reasons leading to communication of intracranial and extracranial. 20 patients of communicative lateral skull base diseases were treated with various operations according their lesions and the important vascular, cranial nerve, audioorgan and lateral skullbasebrain tissue were protected or reconstructed. Six patients with tumor of internal audiocanal (IAC) accepted translabyrhithine approach, one patient with lesion of jugular foramen accepted the operation of drainage to the mastoid cavity. Four patients with tumor of temporal bone accepted operation to remove the lesion. Two patients of otitis media with brain abscess were firstly treated by neurosurgeon, then accepted enlarged mastoidectomy. Two patients with cerebrospinal fluid otorrhea of Mondini dysplasia were treated by translabyrhithine approach. Five patients with cerebrospinal fluid otorrhea of temporal bone fracture, accepted repair operation of cerebrospinal fluid otorrhea. Results Three patients with tumor of IAC were neuroma, three were facial nerve tumor, one was cholesterol granuloma of jugular foramen, four were primary cholesteatoma of temporal, the tumors were removed by operation. There were no recurrence in patients of otitis media with brain abscess after enlarged mastoidectomy, cerebrospinal fluid otorrhea disappeared after operation. The important vascular, cranial nerve, audioorgan and lateral skullbasebrain tissue were protected or reconstructed. Conclusion Surgical treatment is the main method of communicative lateral skull base diseases. The important vascular, cranial nerve, audioorgan and lateral skullbasebrain tissue should be protected or reconstructed.