Endoscopic Endonasal Approach for Petrous Apex Cholesterol Granuloma: Cases Report and Review

Samadian, Mohammad; Dilmaghani, Nader Akbari; Moghaddasi, Habibollah; Vazirnezami, Mohsen; Jabbari, Reza; Rezaee, Omidvar; Rakhshan, Mohammad

doi:10.1055/s-0034-1383939

Cited by 10 publications

(14 citation statements)

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“…Several methods to maintain patency of the opening have been previously described, including scraping of the epithelium, use of nasoseptal flaps, silastic tubes, and nasoseptal flaps with silicon T-tubes. 1,5,6 The use of steroid eluting stent to effectively treat cholesterol granulomas have not been previously described.…”

Section: Discussionmentioning

confidence: 99%

“…The use of silicone tubes and sinonasal mucosa has been successful in preventing stenosis or occlusion of the cyst opening into the nasal cavity. 1,5,6 Simple attempts at curetting the epithelium at the cyst opening to create a permanent ventilation system has also been described. 3 Although the isolated use of silicone T-tube has been reported, Shibao et al described a technique for placement of a vascularized nasoseptal flap into the cyst cavity, followed by an insertion of a 7 mm silicone T-tube to maintain patency.…”

Section: Introductionmentioning

confidence: 99%

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Novel Application of Steroid Eluting Stent in Petrous Apex Cholesterol Granuloma

et al. 2018

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Objective This study describes the safety and efficacy of mometasone furoate eluting stents in the management of petrous apex cholesterol granuloma approached through an endonasal endoscopic route and assesses the restenosis rate. Methods Consecutive patients undergoing endoscopic endonasal marsupialization of a petrous apex cholesterol granuloma at a tertiary referral center who had a mometasone furoate eluting stent placed intraoperatively were reviewed in a retrospective fashion. Postoperative endoscopy was used to determine success of surgery and stenting. Results Five patients were included in the study, three were primary cases and two patients had revision surgeries performed. The steroid eluting stent was placed successfully and safely in all patients with no dural or vascular injuries. The average follow-up duration was 10.6 months. There was no restenosis in three patients and one patient had an immediate restenosis that was debrided in clinic (revision case). This was patent at the 16 months follow-up. One patient also developed stenosis, 4 months after surgery due to sphenoid sinusitis. Conclusion Mometasone furoate eluting stents are safe and effective in the primary management of petrous apex cholesterol granuloma. Further studies are needed to assess their efficacy in revision cases and for long term results.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Novel Application of Steroid Eluting Stent in Petrous Apex Cholesterol Granuloma

et al. 2018

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“…14 Including the present case, 19 cases of PACG have been treated through an endoscopic endonasal approach (►Table 1). 3,[7][8][9][10][11][12][13] Of the 19 patients, 16 have been drained initially through a medial transsphenoidal approach (with or without lateralization of the ICA). Of these 16 patients, 3 developed a symptomatic recurrence that required repeat surgery.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Endonasal Management of Recurrent Petrous Apex Cholesterol Granuloma

et al. 2012

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Introduction?Petrous apex cholesterol granulomas (PACGs) are uncommon lesions. Recurrence following transcranial or endonasal approaches to aerate the cyst occurs in up to 60% of cases. We describe the technical nuances pertinent to the endonasal endoscopic management of a recurrent symptomatic PACG and review the literature. Results?A 19-year-old woman presented with a recurrent abducens nerve paresis. Four months prior, she underwent an endonasal transsphenoidal surgery (TSS) for drainage of a symptomatic PACG. Current imaging documented recurrence of the right PACG. Transsphenoidal and infrapetrous approaches were performed to obtain a wider bony opening along the petrous apex and drain the cyst. A Doyle splint was inserted into the cyst's cavity and extended out into the sphenoid sinus, maintaining patency during the healing process. Three months after surgery, the splint was removed endoscopically, allowing visualization of a patent cylindrical communication between both aerated cavities. The patient remains symptom-free and recurrence-free. Conclusion?Endoscopic endonasal surgery must be adapted to manage a recurrent PACG. A TSS may not be sufficient. An infrapetrous approach with wider bony opening, extensive removal of the cyst's anterior wall, and the use of a stent are indicated for the treatment of recurrent PACG and to prevent recurrences.

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“…Direct resection using a middle fossa approach would yield relatively few recurrences, but it is quite invasive and has a risk of severe postoperative complications [3][4][5][6]. Recently, many reports on endoscopic transsphenoidal surgery (TSS) for PACG drainage have been published [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. Although it is a less invasive approach, the frequency of recurrence is high compared with direct resection.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic transsphenoidal surgery using pedicle vascularized nasoseptal flap for cholesterol granuloma in petrous apex: A technical note

Ishi

Kobayashi

Motegi

et al. 2016

Neurologia i Neurochirurgia Polska

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Abbreviations for this paper: CG = cholesterol granuloma, CT = computed tomography, MRI = magnetic resonance imaging, PA = petrous apex, PACG = petrous apex cholesterol granuloma, PVNF = pedicle vascularized nasoseptal flap , SPA = sphenopalatine artery, TSS = transsphenoidal surgery. AbstractBackground Compared with surgical resection, endoscopic transsphenoidal surgery (TSS) for cholesterol granuloma

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Endoscopic Endonasal Approach for Petrous Apex Cholesterol Granuloma: Cases Report and Review

Cited by 10 publications

References 0 publications

Novel Application of Steroid Eluting Stent in Petrous Apex Cholesterol Granuloma

Novel Application of Steroid Eluting Stent in Petrous Apex Cholesterol Granuloma

Endoscopic Endonasal Management of Recurrent Petrous Apex Cholesterol Granuloma

Endoscopic transsphenoidal surgery using pedicle vascularized nasoseptal flap for cholesterol granuloma in petrous apex: A technical note

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