Endoscopic Transphenoidal Approach to Petrous Apex Lesions: Our Experience and Review of Literature

Introduction: Traditionally, lesions of the petrous apex have been accessible via open, infracochlear, and transtemporal approaches. Transsphenoidal endoscopic removal of petrous apex lesions is a recent advance in the extended applications of sinus surgery. Because of the limited number of case series in the literature, there is limited evidence of recurrence rates and outcomes following endoscopic endonasal management. We describe a series of four cases in which the endoscopic transsphenoidal approach was used to manage this lesion. The purpose of this study is to determine the surgical outcomes of endoscopic endonasal approaches in the treatment of different pathologies of petrous apex.

Study Design: Case series.

Setting: A tertiary care center.

Methods: We report 4 cases of petrous apex lesion (3 cholesterol granuloma, 1 epidermoid) over a period of 3 years that were treated via endoscopic transphenoidal route using four-hand, two –nostril technique with a 4mm, 0 degree to 45 degree endoscope.

Results: The main outcome measures were symptom resolution and postoperative complications. The study included 4 patients (3 males, and 1 female).The mean duration of follow-up was 8 months (range 6- 24 months). No post-operative complications such as CSF leak, meningitis or encepholocele and no signs of recurrence have been noticed.

Conclusion: The endoscopic endonasal approach to petrous apex lesions is safe and effective for appropriately selected patients in the hands of experienced endoscopic skull base surgeons. It avoids craniotomy, spares nerve injuries, and shortens recovery with minimal postoperative morbidity and hospital stay. Based on current literature, endoscopic endonasal approaches result in a high rate of symptom improvement or resolution.