The term petrous apicectomy refers to a group of surgical approaches utilized to access the petrous apex of the temporal bone. The petrous apex is the portion of the petrous bone located anterior to the internal auditory canal. Due to its location medial and anterior to the labyrinth and its relationship with other vital structures such as the horizontal (intrapetrous) segment of the internal carotid artery, obtaining access can be difficult and requires a thorough knowledge of temporal bone anatomy.