This paper describes the diagnostic investigations and surgical treatment of a patient with bilateral lesions of the petrous apices. Many surgical methods were considered before choosing one that would allow simultaneous drainage and hearing preservation. A transsphenoidal, transclival route was used and the surgical goals achieved. A review of the pertinent otologic, neurosurgical and radiologic literature is presented. To our knowledge, this is the first case report in the English language of the transclival approach to both petrous apices.
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