ABSTRACT
The petrous apex remains a huge challenge as it is situated at the frontier between otology and neurosurgery. Situated lateral and adjacent to the clivus, the petrous apex is that part of the temporal bone anterior to the internal auditory meatus that is wedged between the posterior border of the greater wing of the sphenoid and the basilar part of the occipital bones. The most common disease process affecting the petrous apex was infection. The accumulation of pus or development of an osteitis may give rise to all or part of a triad of symptoms and signs that constitute Gradenigo's syndrome. Eccentric chordomas are extremely rare and chordoma in the petrous apex is far more commonly the result of spread from the clivus. It is then usually part of an extensive, multifocal tumour. Proton beam therapy does have a part to play in the management of this disease and has gained some popularity.
