PETROUS APEX LESIONS

The purpose of this article is to detail our experience in treating 69 patients over the past 6 years with pathologic processes involving th e petrous apex. These included 25 (36%) primary petrous apex lesions, 40 (58%) lesions that involved the petrous apex by direct invasion fro m an adjacent region, and four (6%) lesions that were the result of me tastatic spread from a distant site. Although lesions of the petrous a pex are uncommon, they may present significant morbidity to the patien t. The symptoms elicited by these lesions are usually vague and nonloc alizing in the early stages but may progress to include multiple crani al neuropathies. Successful results are contingent on early diagnosis, which requires a high index fo suspicion and use of appropriate imagi ng modalities. Thorough preoperative assessment with use of computed t omography, magnetic resonance imaging, and carotid arteriography is es sential to plan the surgical approach. We present this collection of p atients in order to aid in the further preoperative characterization o f the differences in primary and secondary lesions of the petrous apex .