Management of Lesions of the Petrous Apex

Objective: Diseases affecting the petrous apex (PA) not only tend to have serious morbidities due to the affliction of important structures in the vicinity, but they are also difficult to approach surgically due to the deep location in the skull base. Multiple pathologic processes may affect the PA that range from infection, such aspetrous apicitis, to complex tumors, such as chondrosarcomas. Study Design: Retrospective case study and literature review. Setting: Tertiary referral cranial base center, Gruppo Otologico, Piacenza-Rome, Italy. Patients and Methods: A total of 312 patients with lesions involving the PA preoperatively were included in the analysis. The clinical features, investigations, surgical approach, postoperative complications, and follow-up were noted. Results: Overall 179 patients were diagnosed with petrous bone cholesteatoma, 54 with petrous meningiomas, 19 with chondrosarcoma, 15 with chordoma, 15 with facial nerve tumors, 12 with temporal bone malignancies, 7 with Meckel cave lesions, 5 with giant cell tumors, and 13 with miscellaneous tumors. Conclusions: In the past, attempts at surgical excision of lesions of the PA were fraught with serious complications and morbidities. However, in the era of modern skull base surgery, this is no longer the case. Tumors involving the temporal internal carotid artery are no longer deemed inaccessible or inoperable due to the development of appropriate surgical approaches and the technique of stenting.