Skip to main content Accessibility help
×
Home

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

  • G Dhanasekar (a1) and N S Jones (a1)

Abstract

Objective:

We report a case of cholesterol granuloma of the petrous apex which was surgically treated via an endoscopic trans-sphenoidal approach.

Methods:

Case report and review of the literature concerning cholesterol granulomas of the petrous apex and their management.

Results:

The lesion was approached endoscopically via a bilateral sphenoidotomy with removal of the vomer. A large cholesterol granuloma was evacuated and marsupialised. The patient made an uneventful recovery.

Conclusion:

Trans-sphenoidal access to the petrous apex represents an alternative route for the drainage and ventilation of cholesterol granulomas. This approach is the technique of choice when the cholesterol granuloma abuts the posterior wall of the sphenoid sinus. The trans-sphenoid approach, unlike other lateral approaches to the petrous apex, spares cochlear and vestibular function and allows post-operative endoscopic follow up.

Copyright

Corresponding author

Address for correspondence: Mr G Dhanasekar, 6 Woodhayes Croft, Wolverhampton WV10 8PP, UK E-mail: dhanasekarENT@aol.com

Footnotes

Hide All

Presented at the British Rhinological Society meeting, 21 May 2010, Solihull, UK

Footnotes

References

Hide All
1Brackmann, DE, Toh, EH. Surgical management of petrous apex cholesterol granulomas. Otol Neurotol 2002;23:529–33
2House, WF. Middle cranial fossa approach to the petrous pyramid. Arch Otolaryngol 1963;78:460–7
3House, WF, Histelberger, WE. The transcochlear approach to the skull base. Arch Otolaryngol 1976;102:234–42
4Haberkamp, TJ. Surgical anatomy of the transtemporal approaches to the petrous apex. Am J Otol 1997;18:501–6
5Samadian, M, Vazirnezami, M, Moqaddasi, H, Rakhshan, M, Khormaee, F, Ashraf, H. Endoscopic transrostral-transsphenoidal approach to petrous apex cholesterol granuloma: case report. Turk Neurosurg 2009;19:106–11
6Georgalas, C, Kania, R, Guichard, JP, Sauvaget, E, Tran Ba Huy, P, Herman, P. Endoscopic transsphenoidal surgery for cholesterol granulomas involving the petrous apex. Clin Otolaryngol 2008;33:3842
7Presutti, L, Villari, D, Marchioni, D. Petrous apex cholesterol granuloma: transsphenoid endoscopic approach. J Laryngol Otol 2006;120:e20. Epub 2006 May 15
8DiNardo, LJ, Pippin, GW, Sismanis, A. Image-guided endoscopic transsphenoidal drainage of select petrous apex cholesterol granulomas. Otol Neurotol 2003;24:939–41
9Michaelson, PG, Cable, BB, Mair, EA. Image-guided transphenoidal drainage of a cholesterol granuloma of the petrous apex in a child. Int J Pediatr Otorhinolaryngol 2001;57:165–9
10Meyer, C. Fremdkorperperitonitis with the formation of riesenzellhaltigen Knotchen by encapsulation of cholesterol plaques [in German]. Zieglers Beitr 1893;13:76
11Manasse, P. About granulomas with Fremdkorperriesenzellen [in German]. Virchows Arch 1894;136:245
12Wagner, D. Crystals and giant cell formation in Mittelohreitenungen [in German]. Ver Otol Ges 1904;16:138
13Beaumont, GD. Cholesterol granuloma. J Otolaryngol Aust 1967;2:2835
14Hiraide, F, Inoye, T, Miyakogama, N. Experimental cholesterol granuloma. Histopathological and histochemical studies. Laryngol Otol 1982;96:491501
15Chao, TK. Cholesterol granuloma of the maxillary sinus. Eur Arch Otorhinolaryngol 2006;263:592–7
16Thedinger, BA, Nadol, JB Jr, Montogomery, WW, Thedinger, BS, Greenberg, JJ. Radiographic diagnosis, surgical treatment and long-term follow-up of cholesterol granulomas of the petrous apex. Laryngoscope 1989;99:896907
17Lo, WW, Solti-Bohmann, LG, Brackmann, DE, Gruskin, P. Cholesterol granuloma of the petrous apex: CT diagnosis. Radiology 1984;153:705–11
18Goldofsky, E, Hoffman, RA, Holliday, RA, Cohen, NL. Cholesterol cysts of the temporal bone: diagnosis and treatment. Ann Otol Rhinol Laryngol 1991;100:181–6
19Sabin, HI, Vordi, LT, Symon, L. Epidermoid cysts and cholesterol granulomas centered on the posterior fossa: twenty years of diagnosis and management. Neurosurgery 1987;21:793805
20Montgomery, WW. Cystic lesions of the petrous apex: transsphenoidal approach. Ann Otol Rhinol Laryngol 1977;86:429–35
21Fucci, MJ, Alford, EL, Lowry, LD. Endoscopic management of a giant cholesterol cyst of the petrous apex. Skull Base Surg 1994;41:52–8
22Casiano, RR. Intraoperative image-guided technology. Arch Otolaryngol Head Neck Surg 1999;125:1275–8
23Klimek, L, Mosges, G, Laborde, G, Korves, B. Computer-assisted image-guided surgery in pediatric skullbase procedures. J Pediatric Surg 1995;30:1673–6
24Zinreich, SJ, Tebo, SA, Long, DM, Brem, H, Mattox, DE, Loury, ME et al. Frameless stereotaxic integration of CT imaging data: accuracy and initial applications. Radiology 1993;188:735–42

Keywords

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

  • G Dhanasekar (a1) and N S Jones (a1)

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed