Otogenic intracranial infections usually require both neurosurgical and otolaryngological surgery. This prospective, non-randomized study investigated the value of combining both surgical procedures. Thirteen patients with otogenic intracranial abscess were treated by mastoidectomy and abscess removal through the same incision between 1993 and 2002. Another 12 patients underwent abscess removal or mastoidectomy followed by the other procedure within 7 days. The clinical features of the patients were compared. Four patients died in our series. All four patients had Glasgow Coma Scale (GCS) scores of 7 or less. The preoperative GCS score was the main factor in mortality. One patient had recurrence after the combined approach compared to nine patients with recurrence after separate procedures. The surgical procedure was the main factor affecting the recurrence rate. The combined approach and total capsule excision of the abscess may reduce the risk of recurrence of otogenic intracranial abscess.