The Natural History and Management of Petrous Apex XXXX @entity738 .

@entity1 @entity129 @entity738 @entity130 @entity51 @entity397 @entity1296 @entity10 @entity165
OBJECTIVE: To evaluate the clinical and radiographic characteristics of @entity165 @entity738 of the petrous apex, as well as the outcomes of operative and conservative management. STUDY DESIGN: Retrospective chart review. SETTING: Two independent tertiary academic referral centers. @entity1 : Adult and pediatric @entity1 with @entity165 @entity738 of the petrous apex were identified from the experience of two separate centers. @entity1 were included after radiographic diagnosis and clinical evaluation. All @entity1 with less than 6 months of follow-up and those with iatrogenic postoperative @entity165 @entity738 were excluded. INTERVENTION: Demographic information, presenting symptoms, imaging characteristics, treatment strategies, and outcomes were recorded. MAIN OUTCOME MEASURES: @entity1 were evaluated on the basis of symptom and radiographic evolution during time, with or without operative intervention. RESULTS: Ninety petrous apex @entity165 @entity738 were analyzed (57.8% females, 55.6% right-sided). The average age at presentation was 43.1 years (median 42.0, range 8.0-77.0 years). The most common presenting symptom was @entity10 (56.7%), and the average lesion size in the greatest dimension was 2.1cm (median 1.7, range 0.7-5.0cm). During a mean follow-up of 46.0 months, no cases of spontaneous @entity397 or @entity130 occurred. Twenty-three @entity1 (25.6%) ultimately underwent surgical management, most commonly for intractable @entity10 , and only 47.8% of these @entity1 experienced durable symptom improvement by their last postoperative follow-up. CONCLUSION: Many @entity165 @entity738 of the petrous apex remain stable during time and can be safely managed with primary observation. Surgery should be reserved for lesions that are causing, or threatening, @entity51 because of mass effect or erosion of critical structures such as the otic capsule. @entity129 associated with @entity165 @entity738 may improve after operative management; however, symptoms such as @entity10 and @entity1296 are less likely to benefit from surgery. As a general guideline, in the presence of a radiologically stable @entity165 @entity738 in the petrous apex, alternative etiologies for @entity10 and @entity1296 should be considered and treated before offering surgical intervention.
