The review of papers, focused on studying various neoplasms, diagnosis, selection of surgical approach, complications, and recurrence rates of the petrous apex lesions, that have been published in 2008–2022, is provided. Effusion, mucocele, cholesterol granuloma, cholesteatoma are the most common benign lesions of the petrous apex. Such surgical approaches as translabyrinthine, transcochlear, endoscopic endonasal approach and the middle cranial fossa approach are most often used during treatment. The middle cranial fossa approach, infracochlear approach and endoscopic transnasal approach are recommended for patients with preserved hearing. In case of disseminated lesions, when the carotid artery and the jugular bulb should be additionally controlled, transcochlear and translabyrinthine surgical corridors could be used.