Endoscopic endonasal transpterygoid approach to petrous pathologies: technique, limitations and alternative approaches

The endoscopic endonasal transpterygoid approach is a versatile technique, providing direct access to the petrous apex through an anterior surgical corridor. In this review we detail the transpterygoid approach to the petrous apex and highlight its relative indications. Although this approach is a useful strategy for many lesions of the petrous apex, disease extension into lateral, superior, or posterior compartments may limit extent of resection afforded by an anterior approach alone. Based on these considerations, a disease compartment-specific strategy is discussed. The limitations of the transpterygoid approach and indications for lateral and postero-lateral approaches to petrous pathology are reviewed.