Bilateral Cholesterol Granulomas of the Temporal Bone

Eby, Thomas L.; Guthrie, Barton L.

doi:10.1159/000027617

ORL

1998

DOI: 10.1159/000027617

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Bilateral Cholesterol Granulomas of the Temporal Bone

Thomas L. Eby¹,

Barton L. Guthrie

Abstract: Cholesterol granulomas of the temporal bone without clinical symptoms of chronic otitis media may result from an indolent inflammatory process caused by a congenitally blocked group of air cells. A unique case of giant bilateral cholesterol granulomas of the temporal bone is presented to support this theory. Management allowed bilateral surgical removal with hearing preservation. The differentiation between cholesterol granuloma, giant cholesterol cyst and other lesions of the temporal bone is discussed. The p… Show more

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Cited by 5 publications

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“…They can present with hearing loss and dizziness because of their effects on the hearing and balance mechanisms; they can also cause diplopia, facial palsy/hemifacial spasm, and facial hypesthesia (because of effects on cranial nerves VI, VII, and V, respectively) (1,2). They have infrequently been reported as being bilateral (3)(4)(5)(6)(7)(8)(9). Imaging of the lesions with computed tomography (CT) and magnetic resonance imaging (MRI) can help differentiate cholesterol granulomas from other lesions on the basis of a characteristic appearance.…”

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Bilateral Cholesterol Granulomas

Verret

Samy²

2005

Otology &Amp; Neurotology

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Lesions of the petrous apex can be broken down into several categories: benign versus malignant, primary versus metastatic, vascular versus nonvascular, and solid versus cystic. Cholesterol granulomas are cystic lesions. They are giant cell granulomatous reactions to cholesterol noted from the breakdown of blood and are the most common lesions of the petrous apex. They can present with hearing loss and dizziness because of their effects on the hearing and balance mechanisms; they can also cause diplopia, facial palsy/hemifacial spasm, and facial hypesthesia (because of effects on cranial nerves VI, VII, and V, respectively) (1,2). They have infrequently been reported as being bilateral (3-9). Imaging of the lesions with computed tomography (CT) and magnetic resonance imaging (MRI) can help differentiate cholesterol granulomas from other lesions on the basis of a characteristic appearance. Several surgical approaches have been used for their drainage based primarily on location, size, and hearing status. We present the case of a patient who presented with bilateral cholesterol granulomas drained via a transsphenoidal approach. We then review the English literature reports of bilateral cholesterol granulomas. CASE REPORTA 36-year-old African-American male physician with a long history of eustachian tube dysfunction and rightsided hearing loss presented to his primary care physician with a complaint of acute decrease in hearing in his left ear, headache, and right-sided facial numbness. The patient reported no recent history of otorrhea and had a previous unsuccessful repair of a left tympanic membrane perforation many years previously. The audiogram (Fig. 1) showed a bilateral mixed hearing loss greater on the right side than on the left. A CT scan showed bilateral soft-tissue densities in the petrous apices with bony expansion (Fig. 2). MRI scans obtained with and without gadolinium demonstrated these lesions to have increased signal intensity on T1- (Figs. 3 and 4) and T2-weighted (Fig. 5) images without evidence of gadolinium enhancement. Thus, it was felt that he had bilateral cholesterol granulomas. The patient was transferred to our tertiary care medical center after initial imaging. On presentation, the patient was noted to have a right VIth nerve palsy and right facial hypesthesia. After consultation with ophthalmology, the patient was given steroids to decrease inflammation and improve his vision. Because of the size of the lesions and their proximity to the sphenoid sinuses, the patient underwent a sublabial transsphenoidal approach to drain his cholesterol granulomas. On opening the sphenoid ostium, the lesion was clearly apparent. The lesion was widely opened into the sphenoid sinus. No drains were placed, and the sphenoid sinus was left open to drain into the nasopharynx. Postoperatively, the patient's VIth nerve palsy completely resolved. In addition, his Vth nerve symptoms resolved and his hearing returned to baseline (Fig. 6). Final pathologic findings were consistent with cholesterol granuloma. His...

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confidence: 99%

Bilateral Cholesterol Granulomas

Verret

Samy²

2005

Otology &Amp; Neurotology

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Atypical radiographic features of skull base cholesterol granuloma

Dinh

Goncalves

Bhatia

et al. 2015

Eur Arch Otorhinolaryngol

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Cholesterol granulomas (CGs) are the most common benign lesions of the petrous apex (PA) and have distinct computed tomography (CT) and magnetic resonance imaging (MRI) characteristics. On CT, CGs of the PA (PACG) present as expansile lesions with erosion of bony trabeculae. MRI shows a hyperintense lesion on T1-and T2-weighted images and do not enhance with gadolinium. The objective is to describe the radiographic features of CGs of the skull base that do not arise from the PA. This study is a retrospective review. Three patients were operated on for suspected recurrent endolymphatic sac tumor, intracranial cholesteatoma, and recurrent sphenoid wing meningioma based on CT and MRI findings. Pathology results were consistent with CG in all three cases. All patients had bone erosion on CT. These skull base CGs did not demonstrate similar MRI features. These lesions were hyperintense, iso-to-hyperintense, and hypointense on T1-weighted MRI, respectively. These CGs were hyperintense in two cases and iso-to-hyperintense in one case on T2-weighted MRI. These lesions either demonstrated central or rim enhancement after gadolinium administration. Skull base CGs that do not arise from the PA demonstrate a broad spectrum of radiographic characteristics on MRI that are not typical of PACG.

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Intracranial tuberculoma in an immunocompetent patient

Berk¹

2004

Acta Neurochirurgica

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Bilateral Cholesterol Granulomas of the Temporal Bone

Cited by 5 publications

References 8 publications

Bilateral Cholesterol Granulomas

Bilateral Cholesterol Granulomas

Atypical radiographic features of skull base cholesterol granuloma

Intracranial tuberculoma in an immunocompetent patient

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