Management of Petrous Apex Lesions

Franklin, Daniel J.; Jenkins, Herman A.; Horowitz, Barry L.; Coker, Newton J.

doi:10.1001/archotol.1989.01860330111030

Cited by 25 publications

(9 citation statements)

References 13 publications

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“…Care must be taken not to confuse the hyperintensity of bone marrow of the petrous apex on T1-weighted imaging with disease. Comparison with the contralateral petrous apex and assessment of pneumatization with the CT scan can differentiate the normal variant anatomy from true disease (12).…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

Bilateral Cholesterol Granulomas

Verret

Samy²

2005

Otology &Amp; Neurotology

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“…Primary lesions account for approximately 40% of petrous apex lesions. [1][2][3][4][5][6] PATHOPHYSIOLOGY OF CHOLESTEROL GRANULOMA Cholesterol granuloma of the petrous apex forms as a result of foreign-body giant-cell reaction to cholesterol crystals. The poor ventilation, interference with drainage, and hemorrhage in a usually pneumatized space are predisposing factors leading to the formation of the cyst.…”

Section: Anatomy and Epidemiologymentioning

confidence: 99%

“…Primary petrous apex lesions are those that arise from the central petrous apex or the anatomic boundaries of the region, and account for approximately 40% of petrous apex lesions. [1][2][3][4][5][6] Secondary lesions impinge on the petrous apex from an outside source, which may derive from invasion from a bordering region or from a metastatic lesion; secondary lesions account for the remaining 60% of petrous apex lesions.…”

mentioning

confidence: 99%

Cholesterol Granuloma of the Petrous Apex

Gore¹,

Zanation²,

Ebert³

et al. 2011

Otolaryngologic Clinics of North America

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“…Although temporal bone CT has high sensitivity of detection, its specificity is low because it is not a contrast-enhanced image, and occasionally the findings are similar to those of granulation tissue, secretions, cholesterol granuloma, or neoplasm, particularly when the lesion is not accompanied by changes in bone (4). Congenital cholesteatoma requires a complete resection to prevent recurrence, whereas treatment for cholesterol granuloma or secretions is marsupialization (5,6). Therefore, the preoperative diagnosis of cholesteatoma is important.…”

Section: Introductionmentioning

confidence: 99%