When centered in the petrous apex, meningiomas behave like other neoplasms occurring in that region. The petrous apex can be approached by several routes: posterior craniectomy; middle fossa craniectomy; translabyrinthine, transcochlear, and transeth-moidosphenoid approaches. A patient harboring a malignant meningioma in her petrous apex is presented. A middle fossa craniectomy, coupled with posterior displacement of the facial nerve, allowed access to the entire temporal bone from above. The patient received postoperative irradiation.