Radiographic diagnosis, surgical treatment, and long‐term follow‐up of cholesterol granulomas of the petrous apex

Abstract

Cholesterol granuloma is an unusual lesion of the petrous apex. Accurate preoperative differentiation of the various lesions of the petrous apex by computed tomography scanning only has been difficult. We reviewed the clinical findings, computed tomography and magnetic resonance imaging scans, surgical approaches, and long-term follow-up in 10 patients with cholesterol granuloma of the petrous apex who were seen between 1971 and 1988. Headache and deficits of the 5th, 6th, 7th, and 8th cranial nerves were common presenting symptoms. Magnetic resonance imaging with special imaging techniques was accurate in diagnosing cholesterol granuloma in four patients preoperatively and three patients prior to revision surgery. The optimal surgical approach was chosen on the basis of clinical and radiographic findings and included the transsphenoidal, infralabyrinthine, transcochlear, and suboccipital routes. Our review reveals that magnetic resonance imaging is more specific than computed tomography in establishing a preoperative diagnosis and is also the technique of choice in follow-up. The long-term results are discussed.

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

“…Similar to our case, endoscopic TSS using pedicle flap for PACG has been reported to achieve good outcomes [10,11,14,22]. Although the obstruction of the drainage route is a major cause of recurrence [27], post-operative CT in our case revealed a regenerated mucosa covering the inner side of CG, probably because PVNF was able to prevent the obstruction. Some reports recommend additional use of artificial material, such as silastic stent [10,11], to prevent restenosis of the drainage route.…”

“…In general, TSS is indicated for lesions that abut the posterior wall of the sphenoid sinus [19]. Before the advent of endoscopic surgery, the recurrence rate following microscopic TSS for PACG was quite high [27]. In recent years, however, the recurrence rate of endoscopic TSS has extremely reduced [10,12,16,22].…”

Large Cholesterol Granuloma Arising From the Frontal Sinus. Case Report.

“…9,[12][13][14]17,19) However, mucocele with intraluminal hemorrhage often shows a similar intensity pattern. 20) Puncture and investigation of the cyst content may be useful to differentiate cholesterol granuloma from mucocele with hemorrhage. In our case, we did not puncture the cyst preoperatively, because the mass had destroyed the inner table of the skull, and plastic repair of the anterior skull base after craniotomy would be needed whether the lesion was cholesterol granuloma or mucocele.…”

“…8,20) Cholesterol granuloma arising from the frontal sinus without facial deformity may also be treated by only drainage of the cyst content. However, large cholesterol granuloma with facial deformity, such as our case, is always associated with destruction of the skull bone and cosmetic problems.…”

Endoscopic trans-sphenoidal removal of cholesterol granuloma of the petrous apex: case report and literature review

“…15 Cholesterol granulomas of the petrous apex are uncommon, because this site is pneumatised in only 30 per cent of temporal bones; the incidence is less than 0.6 cases per million population per year. 16,17 Petrous apex cholesterol granulomas tend to remain clinically silent, but as the lesion expands, headaches and cranial neuropathies may arise, impairing hearing, balance, speech and swallowing. 18 Contralateral involvement of cranial nerves may be seen.…”