Petrous Apex Cholesterol Granuloma Revealed by Facial Palsy

Fieux, M.; Daubie, Sophie; Pialat, Jean‐Baptiste; Tringali, S.

doi:10.1002/ana.25924

Cited by 4 publications

(2 citation statements)

References 6 publications

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“…Intervention is necessary as progressive facial nerve compression by the PACG can lead to facial palsy. 10 The small PACG in this patient did not expand anteromedially and was located lateral to the genu of paraclival ICA and horizontal petrous ICA, which made the EE approach more challenging because of the risk of ICA injury. The EMF approach used in this patient provided a wide surgical view, safe drilling of the petrous bone around PACG using the technique of anterior petrosectomy, wide exposure and complete decompression of PACG, and IAC decompression, resulting in complete symptomatic resolution.…”

Section: Discussionmentioning

confidence: 80%

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Cyst-to-Mastoid Antrum Diversion as an Alternate Pathway for Management of Small Symptomatic Petrous Apex Cholesterol Granuloma Without Anteromedial Expansion Using an Extradural Middle Fossa Approach: A Technical Case Report

Yamakami

Kubota

Higuchi

et al. 2022

Operative Neurosurgery

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BACKGROUND AND IMPORTANCE: Cholesterol granuloma (CG) is the most common petrous apex (PA) cystic lesion. Posterolateral expansion of a PA CG (PACG) compresses the internal auditory canal (IAC), leading to vestibulocochlear (VC) and facial nerve dysfunction. Even small, symptomatic PACGs are managed surgically. The preferred strategy is not complete removal, but drainage and aeration. PACG with anteromedial expansion using an endoscopic endonasal approach provides natural drainage into the nasal sinus without risking VC and facial dysfunction. Endoscopic endonasal approach is inappropriate for small PACGs without anteromedial expansion because of potential damage to the petrous internal carotid artery. Small PACGs without anteromedial expansion are managed using extradural middle fossa (EMF) approach, which lacks a natural drainage pathway, thus necessitating an artificial drainage pathway for PACG aeration to prevent recurrence. We introduced EMF approach for CG decompression and cyst-tomastoid antrum (MA) diversion for managing small, symptomatic PACGs without anteromedial expansion. CLINICAL PRESENTATION: A 48-year-old woman presented with headache, vertigo, tinnitus, and left hemifacial spasm with preserved hearing because of IAC compression caused by a small PACG without anteromedial expansion. Using the EMF approach, the CG and IAC were safely decompressed. Effective and long-standing artificial drainage for CG aeration was established by anterior petrosectomy and silicone tubing from the CG into the MA. Surgery resolved the symptoms, which have not recurred in 3 years. CONCLUSION: Granuloma decompression and cyst-to-MA diversion using silicone tubing using the EMF approach is a safe and effective surgical management for small, symptomatic PACG without anteromedial expansion.

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Section: Discussionmentioning

confidence: 80%

“…Intervention is necessary as progressive facial nerve compression by the PACG can lead to facial palsy. 10…”

Section: Discussionmentioning

confidence: 99%