Endoscopic approaches to the petrous apex

Arguably one of the most inaccessible regions because of its anatomical location, the petrous apex poses a significant challenge for access to its pathology. In the last 10 years we have seen an impressive evolution of endoscopic techniques, with key advances allowing us to push the limits of endoscopy. Anatomical understanding, instrumentation, and image guidance have greatly contributed to this expansion. These extended endoscopic techniques allow a more direct corridor to the petrous apex without the morbidity posed by lateral or transcranial open approaches. Patients experience a greatly reduced hospital stay, a quicker recovery, and minimal sequelae. Herein we describe the endoscopic approach to the petrous apex.