Indications and advantages of endoscopic trans-sphenoid approach for petrous apex lesions: two case reports

The choice of surgical approach for a petrous apex lesion depends on its relationship with the internal carotid artery, degree of medial expansion and pathology. The correct identification of patients who will benefit from this approach is necessary.

Two adult patients presented with a lesion in the left petrous apex. Computed tomography showed a homogeneous mass extending anteromedially, and abutting the internal carotid artery and the sphenoid sinus in both patients. Using magnetic resonance imaging, a third recurrence of cholesterol granuloma in case one and cholesteatoma in case two were diagnosed. Both patients underwent trans-sphenoid excision, as the sphenoid sinus was well pneumatised and the lesion was medial to the internal carotid artery.

Nasal endoscopic access to the petrous apex via the trans-sphenoid corridor should be preferred for benign lesions extending anteromedially in cases where lateral access is impeded by the internal carotid artery, the labyrinth and the facial nerve, and anterior trans-sphenoidal access offers a low-morbidity alternative.