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Surgical approaches to the petrous apex, such as anterior petrosectomy, were popularized in the 1980s. Original reports concentrated on the anatomy of the approach and small case series. Recently, with the advent of additional endonasal approaches to the petrous apex, it remains unclear as to what is the morbidity of anterior petrosectomy? Here, we report a contemporary series of anterior petrosectomy detailing its complications. Overall 46 consecutive patients identified from our surgical database and were reviewed. Of 46 total patients, 61% were women. Median age of patients was 50. Median follow-up was 66 months. Of the 37 patients with sole anterior petrosectomy, 17 were achieved through a temporal craniotomy, and 20 through a fronto-temporo-orbitozygomatic craniotomy. Most procedures dealt with intradural pathology including meningioma (46%), aneurysms (13%), and …