Symptoms of Petrous Apex Lesions

• Main Authors: Goyal, Neerav, Liu, Jenny, Kanekar, Sangam G., Ghossaini, Soha
• Format: Conference Proceeding
• Language: English
• ISSN: 2193-6331; 2193-634X
• DOI: 10.1055/s-0032-1312340

Background: The petrous apex is a portion of temporal bone lying between the sphenoid bone anteriorly and occipital bone posteriorly. It has a close anatomic relationship with the internal carotid artery, midbrain, pons, and cranial nerves. Pathology in the petrous apex can present either as an incidental finding or as a manifestation of various neurological and cranial nerve deficits. Methods: This is a retrospective review of our experience of patients with petrous apex lesions who presented to the Hershey Medical Center between 2003 and 2011. Patients who had undergone CT or MRI of the temporal bone region with noted petrous apex abnormalities were included. Symptoms at presentation (if any), audiogram data, and treatment modalities were recorded. Imaging appearances of the various processes will be illustrated and clinical significance will be discussed. Results: One hundred and fifteen patients that met inclusion criteria were identified in this retrospective study. Patients were found to have anatomic variations (petrous apex pneumatization, asymmetric fatty marrow, trapped fluid), infection (petrous apicitis, Gradenigo's syndrome), cholesteatoma and cholesterol granuloma, neoplastic lesions (primary involving the bone and secondary metastasis to apex), and vascular pathology (internal carotid artery aneurysm). Of the temporal bone imaging reviewed, 18.3% of the pathology were asymptomatic incidental findings (n = 21), 12.2% were cholesterol granulomas (n = 14), 25.2% were meningiomas (n = 29), 8.7% were internal carotid artery aneurysms (n = 10), and 2.6% represented petrous apicitis (n = 3). The most common presenting symptoms were headache (28.9%, n = 33), visual symptoms (27.8%, n = 32), and hearing loss (24.3%, n = 28). Conclusion: Petrous apex lesions are rare and may remain silent for a long period of time, or may present with nonspecific signs and symptoms. Imaging plays a vital role in diagnosing the normal anatomical variation and classifying the various pathologies.