Petrous apex cholesteatoma

Primary or secondary petrous apex cholesteatoma requires surgical managemen t. We describe here five patients with cholesteatoma in the petrous apex on whom different surgical approaches to this region were used. Translabyrint hine-transcochlear (transotic) approach with VII-XII anastomosis was used i n four patients. In one patient middle fossa approach with otic capsule and facial canal leaving intact was used. All patients are without recurrence of cholesteatoma with improving of the facial nerve function in one case. W e discuss specific pathologies of the petrous apex, the surgical approach t o this region indicated according to the size and type of pathology diagnos ed, hearing loss and facial nerve function. Possible complications of this surgical procedure and their management are also discussed.