Endoscopic Endonasal Approach to Selected Lesions of the Petrous Apex

Surgery of the petrous apex lesions is considered a surgical challenge. We report our experience and review the literature highlighting current indications and limits in the management of benign and malignant lesions with special focus on the endoscopic approaches. Over the last years, indications and limits of the extended endonasal approaches range from inflammatory disease of the paranasal sinuses to the management of various diseases involving the skull base such as CSF leak, pituitary tumors, ethmoid tumors, petrous apex lesions, and purely intracranial lesions thanks to the development of dedicated surgical instrumentation, the improvement of skull base reconstruction techniques, and a better knowledge of the anatomy. Extended endonasal approach to petrous apex lesions is a safe and effective procedure for appropriately selected patients in the hands of experienced endoscopic skull base surgeons. Nowadays, referral centers equipped by surgical teams with expertise to both endoscopic and lateral skull base routes represent the most safe and effective way of treatment of those diseases.