The precochlear approach to the anterior petrous apex: an anatomic study

The petrous apex is the most inaccessible portion of the temporal bone and surgical exposure presents considerable challenge. The transmastoid precochlear approach offers a direct intra temporal route to this region, providing good visual exposure with cochlea preservation. An anatomic study of 20 human temporal bones was performed to delineate the landmarks for this approach. Measurements to the tegmen tympani, carotid artery, and the anterior-superior limit of the cochlea were made from the cochleariform process, a constant landmark in the middle ear. Distances to the tegmen averaged 5.4 mm (range: 3.5-9 mm), to the carotid artery 9.3 mm (8-11 mm), and the cochlea 3.1 mm (2-5 mm). The entry to the apex admitted an average burr size of 3.5 mm (2-7 mm). We anticipate this approach will prove useful in the treatment of benign petrous apex lesions.