Objective: To summarize and analyze the clinical data of petrous cholesteatoma of temporal bone, and to explore the diagnosis and treatment strategy of different types of petrous cholesteatoma. Methods: The imaging data, facial nerve function, hearing, surgical plan and preoperative and postoperative complications of 32 patients with petrous temporal bone cholestatoma were retrospectively studied. Results: Among the 32 patients, according to Sanna classification, 10 cases (31.25%) were suprapyramidal type, of which 3 cases selected the labyrinth approach, 5 cases selected the expanded mastoid approach, 1 case selected the otic capsule approach, and 1 case selected the middle cranial fossa approach combined with mastoid approach.Infralabyrinthine type: 11 cases (34.38%), including 2 cases of otic capsule approach, 7 cases of labyrinthine approach, and 2 cases of enlarged labyrinth approach.1 case (3.12%) of infralabyrinthia-apex type, labyrinthia-petrous approach and endoscopic assistance.There were 9 cases (28.13%) of giant labyrinthal type, including 3 cases of subtotal temporal bone resection, 3 cases of labyrinth approach, 2 cases of otic capsule approach, and 1 case of cochlear approach.One case (3.12%) of petrous apex type was selected through the middle cranial fossa approach.Facial paralysis: there were 10 cases of facial paralysis before operation, accounting for 31.25%, including 1 case of HB grade Ⅱ, 1 case of Hb grade Ⅲ, 2 cases of Hb grade Ⅳ, 2 cases of Hb grade Ⅴ, and 4 cases of Hb grade Ⅵ, and 3 cases of new facial paralysis after operation.There were 21 cases with intracranial and extracranial complications before operation, including 5 cases with brain abscess.Conclusion: The selection of surgical strategies and surgical methods for petrous bone cholestatoma is very important, which should be comprehensively evaluated according to the classification of lesions, facial nerve function, hearing, and whether there are intracranial and extracranial complications.