Pneumatised petrous temporal bone
CT skull base
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Symmetrical bilateral pneumatised petrous temporal bone apices.
Pneumatisation 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 pneumatised petrous apex. Also it can be a site for CSF fistula especially after skull base surgery (e.g. vestibular schwannoma surgery).