Pneumatized petrous temporal bone
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CT skull base
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Symmetrical bilateral pneumatized petrous temporal bone apices.
Pneumatization of the petrous temporal bone apices is an anatomical variant that may be bilateral or asymmetrical. It is important not to confuse it with a pathological lesion especially in MRI.
Benign lesions such as cholesterol granuloma and cholesteatoma are more likely to occur in a pneumatized petrous apex. Also it can be a site for CSF fistula especially after skull base surgery (e.g. vestibular schwannoma surgery).