Double‐barrel stenting in infracochlear approach for drainage of petroux apex cholesterol granulomas

Samy, Ravi N.; Pensak, Myles L.

doi:10.1002/lary.21420

Cited by 5 publications

(5 citation statements)

References 15 publications

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“…Shoman et al (8) described a double-barrel stenting approach to minimize the chance of outflow obstruction. We decided two ports through an infralabyrinthine and subarcute tract were ideal for drainage into mastoid.…”

Section: Discussionmentioning

confidence: 99%

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Minimally Invasive Image-Guided Access for Drainage of Petrous Apex Lesions

Balachandran¹,

Tsai²,

Ramachandra³

et al. 2014

Otology &Amp; Neurotology

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Objective In this case report, we present a novel, minimally-invasive image-guided approach to drainage of a petrous apex lesion. Patient(s) A 34-year-old man diagnosed with a petrous apex lesion consistent with cholesterol granuloma. The granuloma was large and caused mild compression of the brainstem with associated neurologic symptoms and seizure-like activity. Interventions Based on the anatomical location of the lesion, it was determined that the treatment plan would be to surgically drain the lesion via two linear paths—one following an infralabyrinthine approach and the other a subarcuate approach. Customized microstereotactic frames that mount on bone-implanted markers and constrain the drill along the desired path were utilized to accurately drill these desired paths and avoid damage to surrounding critical structures. After a simple mastoidectomy, the petrous apex was successfully reached without damage to vital adjacent structures by drilling the two linear channels using two custom microstereotactic frames. Main Outcome Measures Viscous brown liquid and debris was recovered by irrigating through one of the channels and suctioning through the other. Results Drainage of the petrous apex was successfully performed via two linear channels without any complications. Custom microstereotactic frames were used to accurately drill those linear channels. Post-operative CT ensured no complications. Post-operative course of the patient was remarkable with normal hearing and normal facial nerve function. Conclusion We presented a successful implementation of an image-guided approach to drain petrous apex.

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Section: Discussionmentioning

confidence: 99%

“…To minimize the chance of cyst recurrence, it was decided that a double-barrel stenting approach suggested by Shoman et al (8) would be utilized. This approach required drilling two tracts to the lesion.…”

Section: Case Reportmentioning

confidence: 99%

Minimally Invasive Image-Guided Access for Drainage of Petrous Apex Lesions

Balachandran¹,

Tsai²,

Ramachandra³

et al. 2014

Otology &Amp; Neurotology

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“…However, intraoperative image guidance and meticulous surgical technique allows the precise removal of bone from the clival region with minimal risk to the ICA to reach PA medially. Similarly, the access to PA by TICA can be difficult when there is a high or anteriorly placed JB,16, 17 if the lesion is located anterior and superior to the cochlea, and if there is poor pneumatization of hypotympanum 18…”

Section: Discussionmentioning

confidence: 99%

Petrous apex cholesterol granulomas: Endonasal versus infracochlear approach

et al. 2012

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The transnasal approach provides reliable access to the PA when combined with internal carotid artery exposure and allows for large drainage window. The transcanal approach is less versatile and more limited than the transnasal approach but provides access to the most posterior and inferior portion of the PA without Eustachian tube transection. Here we propose a new surgical classification that may help to decide the most suitable approach to the PA according to the location and extension of the lesion.

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“… 5 , 6 , 7 , 8) Within the temporal bones, cholesterol granuloma is known to occur most commonly in the petrous apex. 9 , 10) With few cases of cholesterol granuloma presenting as a mass in the EAC having been reported, occlusion of the entire EAC by a cholesterol granuloma in a pediatric patient is quite rare. 9 , 10 , 11) A pre-operative diagnosis of the EAC-occluding mass is necessary to devise appropriate treatment, reduce operative complications, reduce post-operative morbidity, and effectively restore hearing.…”

Section: Introductionmentioning

confidence: 99%

“… 9 , 10) With few cases of cholesterol granuloma presenting as a mass in the EAC having been reported, occlusion of the entire EAC by a cholesterol granuloma in a pediatric patient is quite rare. 9 , 10 , 11) A pre-operative diagnosis of the EAC-occluding mass is necessary to devise appropriate treatment, reduce operative complications, reduce post-operative morbidity, and effectively restore hearing. Correct diagnosis of EAC stenosis is challenging in young children owing to the low incidence of EAC masses in the pediatric population.…”

Section: Introductionmentioning

confidence: 99%

A Case of a Cholesterol Granuloma Occluding the External Auditory Canal in a 12-Year-Old Girl

2014

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Cholesterol granulomas are benign granulomatous lesions caused by tissue reaction to a foreign body such as cholesterol crystals. These crystals have been are associated with pathological conditions of pneumatized spaces, including those causing inadequate aeration, obstruction of drainage, and hemorrhage in pneumatized spaces, and where materials trapping materials, such as hemosiderin or cholesterol become trapped, and then forming a cholesterol granuloma. Cholesterol granulomas are frequently found in the temporal bones, with the middle ear, mastoid caverna, and petrous apex being the most commonly affected sites. As there have been few reported cases of cholesterol granulomas presenting as a mass in the external acoustic canal (EAC), a cholesterol granuloma occluding the entire EAC in a pediatric patient is considered quite rare. We encountered a large cholesterol granuloma occupying the entire EAC, resulting in total EAC occlusion in a 12-year-old girl. The granuloma was diagnosed via medical imaging and surgically excised.

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Double‐barrel stenting in infracochlear approach for drainage of petroux apex cholesterol granulomas

Cited by 5 publications

References 15 publications

Minimally Invasive Image-Guided Access for Drainage of Petrous Apex Lesions

Minimally Invasive Image-Guided Access for Drainage of Petrous Apex Lesions

Petrous apex cholesterol granulomas: Endonasal versus infracochlear approach

A Case of a Cholesterol Granuloma Occluding the External Auditory Canal in a 12-Year-Old Girl

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