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Petrous Apex Granulomas: CT and MR Imaging

  • Stephen Hentschel (a1) and Felix Durity (a1)

Extract

A 29-year-old male complained of a four month history of horizontal, spontaneous, and nonprogressive diplopia. On examination he had a mild left sixth nerve palsy. The rest of his general and neurologic examinations were normal.

Computed tomography scanning demonstrated a nonenhancing, well-circumscribed, lesion in the left petrous apex (Figure 1). The opposite apex was well pneumatized. The lesion abutted the medial wall of the horizontal canal of the internal carotid artery and pointed towards the lateral wall of the sphenoid sinus. Unfortunately, CT bone windows were not available for this case but would have been helpful in terms of the differential diagnosis. An MRI demonstrated a predominantly high signal mass on T1 and T2 sequences (Figure 2). The diagnosis was a petrous apex granuloma.

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Copyright

Corresponding author

Felix Durity, Room 300C-700 West 10th Avenue, Vancouver, BC Canada V5Z 4E5

References

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1. Hiraide, F, Inouye, T, Miyakogawa, N. Experimental cholesterol granuloma: histopathological and histochemical studies. J Laryngol Otol 1982;96:491-501.
2. Eisenberg, M, Haddad, G, Al-Mefty, O. Petrous apex cholesterol granulomas: evolution and management. J Neurosurg 1997;86: 822-829.
3. Brodkey, J, Robertson, J, Shea, J, Gardner, G. Cholesterol granulomas of the petrous apex: combined neurosurgical and otological management. J Neurosurg 1996;85:625-633.
4. Ghorayeb, B, Jahrsdoerfer, R. Subcochlear approach for cholesterol granulomas of the inferior petrous apex. Otolaryngol Head Neck Surg 1990;103:60-65.
5. Thedinger, B, Nadol, J Jr, Montgomery, W, et al. Petrous apex cholesterol granulomas: evolution and management. J Neurosurg 1997;86:822-829.
6. Altschuler, E, Jungreis, C, Sekhar, L, et al. Operative treatment of intracranial epidermoid cysts and cholesterol granulomas: report of 21 cases. Neurosurgery 1990;26:606-614.

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Petrous Apex Granulomas: CT and MR Imaging

  • Stephen Hentschel (a1) and Felix Durity (a1)

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