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From 1969 to 1990, 16 patients were treated for petrous apex cholesteatoma invading or extending beyond the internal auditory canal. This type of cholesteatoma poses various specific surgical problems and various surgical procedures are necessary for treatment. To attain maximal therapeutic effect and ensure postoperatively a satisfactory quality of life, the preoperative therapeutic scheme for each individual patient is very important, as is demonstrated by the case study presented here. The therapeutic scheme includes the following: (1) surgical approach; (2) management of a cavity following removal of the cholesteatoma; (3) handling of problems such as involvement of the dura and internal carotid artery; and (4) management of the facial nerve.