Management of petrous apex lesions

Advancements in imaging pose new diagnostic and therapeutic dilemmas as smaller lesions in the relatively inaccessible regions of the petrous apex and clivus are identified. Differentiation of true pathology from artifact and anatomic variants is critical in management of these lesions. We describe our experience with five patients diagnosed with petrous apex lesions: three, cholesteatomas; one, cholesterol granuloma; and one, false-positive. Soft-tissue obliteration of the temporal bone defect with postoperative follow-up using high-resolution computed tomographic scanning and magnetic resonance imaging is proposed as an alternative to exteriorization.