Petrous apex is the most medial structure of the temporal bone. Many important anatomical structures are located near it, such as petrous part of the internal carotid artery, internal auditory canal, the Gasserian ganglion, and VI, VII, and VIII cranial nerve. Lesions of the petrous apex can cause various signs and symptoms depending on their size and location. The most common symptoms include hearing loss, vertigo, headache, facial pain, tinnitus, muscle spasm and paralysis of facial muscles, diplopia, and otorrhea. Symptoms typically appear a few years or months before the diagnosis is made. It's important to note that a large portion of these formations can be asymptomatic and are incidentally diagnosed during the evaluation of patients for other pathologies. The specific position of the apex of the temporal bone makes direct examination difficult and requires detailed radiological evaluation. The treatment of these lesions depends on their histological characteristics, location, growth, and the symptoms they cause. Surgical methods are most commonly used for treating these formations, and due to the position of the apex of the temporal bone and the surrounding structures, it is necessary for the surgeon to be experienced and have a thorough understanding of the anatomy and anatomical variations in this region.