Lesions of the petrous apex

While lesions of the petrous apex are uncommon, they may present significant morbidity to the patient. The symptoms elicited by these lesions are usually vague and nonlocalizing in the early stages but progress to include multiple cranial neuropathies. Early diagnosis requires a high index of suspicion and use of appropriate imaging modalities. Thorough preoperative assessment with use of CT, MRI, and carotid arteriography is essential to plan the optimal surgical approach. Previously considered inaccessible, technical advances in skull base surgery have made this region more approachable.