The petrous apex lies at the anterior superior portion of the temporal bone. Access to this region is difficult and often requires special surgical skills. The region is associated with severe life-threatening complications of otitis media. Improvements in antibiotic therapy, surgery for chronic otitis media, and the development of tympanostomy tubes have decreased incidence of suppurative petrous apicitis. Neoplastic and inflammatory lesions are the most common pathologic processes in the petrous apex. Imaging studies have greatly increased the ability to diagnose these lesions, especially in view of the often-vague symptomatology associated with these lesions. A number of the processes are diagnosed as incidental findings, and consultation is sought to determine the appropriate diagnosis and therapeutic plan. See the image below.
Petrous apicitis. An axial CT scan of the temporal
Petrous apicitis. An axial CT scan of the temporal bone shows an air-fluid level within the right petrous apex and fluid within the middle ear space and mastoid.
Classic studies detailing the anatomy of the apex and development of improved surgical techniques, including the operating microscope and facial nerve monitor, permit access to the region while lowering the morbidity and mortality associated with surgery. Stereotactic radiation is a relatively new therapeutic tool that offers nonsurgical hope for treating some tumors. Diagnostic evaluation and treatment plan determination for the lesions are dynamic processes that have changed significantly over the past 20 years, and they should change significantly over the next 20 years.
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