Otologic surgery of the lateral skull base

Otologic skull base surgery has developed from a salvage treatment of otitic complications into a highly differentiated management of diseases around the petrous bone, involving basically the senses of hearing and equilibrium or the cranial nerves VII-XII. Since thorough training in advanced diagnosis, expensive equipment, and high amount of cases are essential requirements, only few centers can offer the whole spectrum of possible interventions. University departments, in general, are experienced in the removal of large, destructive cholesteatomas or other pseudotumors of the petrous bone. They offer a functional management of glomus temporale tumors as well as acoustic neurinomas. And they are competent in the treatment of skull base injuries and malformations. For the control of larger malignancies, however, a neuro-otosurgical cooperation has proven valuable. Also other lesions around the clivus are best exposed by sophisticated approaches which can be neurosurgical as well as otological. A variety of treatment modalities exist, and a consensus on the ideal access is still lacking.