• Purvee D Patel, Ali Tayebi Meybodi, Pankaj Agarwalla, Robert W Jyung, and James K Liu.
• Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
• World Neurosurg. 2020 Aug 1; 140: 122-127.

BackgroundThe mainstay treatment for petrous apicitis (Gradenigo's syndrome) is medical management with antibiotics, steroids, and placement of pressure equalization tubes. The role for surgery is limited as second-line treatment if conservative methods have failed.Case DescriptionWe report 2 cases of medically refractory petrous apicitis presenting with progressive cranial neuropathies who underwent petrous apex resection and debridement via an anterior petrosal (Kawase) approach. Both patients had improvement of their preoperative cranial nerve deficits within 24-48 hours of surgery, that previously did not improve after 2 weeks of medical management.ConclusionsTo our knowledge, the use of the Kawase approach for petrous apicitis has not been previously reported. In addition, we postulate that surgical intervention can potentially result in quicker recovery of preexisting cranial nerve deficits in medically refractory petrous apicitis. This raises the potential role of earlier surgical intervention.Copyright © 2020 Elsevier Inc. All rights reserved.

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