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Skull base surgery. 1998; 8(1): 23–27.
PMCID: PMC1656663

The Precochlear Approach to the Anterior Petrous Apex

An Anatomic Study


The petrous apex is the most inaccessible portion of the temporal bone and surgical exposure presents considerable challenge. The transmastoid precochlear approach offers a direct intra temporal route to this region, providing good visual exposure with cochlea preservation. An anatomic study of 20 human temporal bones was performed to delineate the landmarks for this approach. Measurements to the tegmen tympani, carotid artery, and the anterior-superior limit of the cochlea were made from the cochleariform process, a constant landmark in the middle ear. Distances to the tegmen averaged 5.4 mm (range: 3.5-9 mm), to the carotid artery 9.3 mm (8-11 mm), and the cochlea 3.1 mm (2-5 mm). The entry to the apex admitted an average burr size of 3.5 mm (2-7 mm). We anticipate this approach will prove useful in the treatment of benign petrous apex lesions.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Chole RA. Petrous apicitis: surgical anatomy. Ann Otol Rhinol Laryngol. 1985 May-Jun;94(3):251–257. [PubMed]
  • Ghorayeb BY, Jahrsdoerfer RA. Subcochlear approach for cholesterol granulomas of the inferior petrous apex. Otolaryngol Head Neck Surg. 1990 Jul;103(1):60–65. [PubMed]
  • Giddings NA, Brackmann DE, Kwartler JA. Transcanal infracochlear approach to the petrous apex. Otolaryngol Head Neck Surg. 1991 Jan;104(1):29–36. [PubMed]

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