Petrous bone cholesteatoma is an uncommon but challenging problem in the diagnosis and treatment for Otologistes. The goals of this study were to analyze the clinical Symptoms and the long-term results of surgery for petrous bone cholesteatoma. Method: this study is a review of 12 cases of cholesteatome involving the petrous bone who were treated at national ENT hospital between 2000 and 2012. Results: 100 percent of the patients presented with hearing loss (58.33 percent- total deafness) and 50 percent presented with facial nerve weakness or paralysis (House grade II to V). CT scan finding releaved frequent direct labyrinthine and supralabyrinthtine cell spead. The surgical approach to be adopted should be based on extent of the disease, the state of the facial nerve, preventation of CSF leakage and of recurrence. The most suitable approaches are the translabyrinthine-transcochlear and the middle fossa. There was no long-term recurrence in 41.66 percent. It is very difficult to remove a cholesteatome matrix completely from dure, facial nerve and caroid artery.