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Petrous apex pathology ranges from extradural cholesterol granulomas, cholesteatomas, asymmetric pneumatization, and osteomyelitis to intradural meningiomas and schwannomas. Certain lesions, such as cholesterol granulomas, can be managed with drainage while neoplastic lesions must be completely resected. Surgical options use open, endoscopic, and combined techniques and are categorized into anterior, lateral, and posterior approaches. The choice of approach is determined by the nature of the pathology and location relative to vital structures and extension into surrounding structures and requires thorough preoperative evaluation and discussion of surgical goals with the patient. The purpose of this state\u2010of\u2010the\u2010art review is to discuss the most commonly used surgical approaches to the petrous apex, and the anatomy on which these approaches are based.<\/jats:p>","DOI":"10.1016\/j.wjorl.2019.11.002","type":"journal-article","created":{"date-parts":[[2020,6,3]],"date-time":"2020-06-03T21:15:02Z","timestamp":1591218902000},"page":"106-114","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":35,"title":["Surgical approaches to the petrous apex"],"prefix":"10.1002","volume":"6","author":[{"given":"Kevin L.","family":"Li","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology \u2013 Head and Neck Surgery Albert Einstein College of Medicine Bronx NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijay","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Albert Einstein College of Medicine Bronx NY 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