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Petrous apex cholesterol granuloma: pictorial review of radiological considerations in diagnosis and surgical histopathology

  • M Hoa (a1) (a2), J W House (a1) (a2), F H Linthicum (a2) and J L Go (a3)

Abstract

Background:

Petrous apex cholesterol granulomas are expansile, cystic lesions containing cholesterol crystals surrounded by foreign body giant cells, fibrous tissue reaction and chronic inflammation. Appropriate treatment relies on an accurate radiological diagnosis and an understanding of the distinguishing radiological features of relevant entities in the differential diagnosis of this condition.

Methods:

Firstly, this paper presents a pictorial review of the relevant radiological features of petrous apex cholesterol granuloma, and highlights unique features relevant to the differential diagnosis. Secondly, it reviews the histopathological and radiological findings associated with surgical drainage of these lesions.

Results:

Radiological features relevant to the differential diagnosis of petrous apex cholesterol granuloma are reviewed, together with radiological and histopathological features relevant to surgical management. Following surgical management, histopathological and radiological evidence demonstrates that the patency of the surgical drainage pathway is maintained.

Conclusion:

Accurate diagnosis of petrous apex cholesterol granuloma is essential in order to instigate appropriate treatment. Placement of a stent in the drainage pathway may help to maintain patency and decrease the likelihood of symptomatic recurrence.

Copyright

Corresponding author

Address for correspondence: Professor John W House, House Research Institute, 2100 West 3rd St, Los Angeles, CA 90057, USA E-mail: jhouse@hei.org

Footnotes

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Professor J W House was one of the JLO Visiting Professors for 2012

Footnotes

References

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1Jackler, RK, Cho, M.A new theory to explain the genesis of petrous apex cholesterol granulomas. Otol Neurotol 2003;24:96106
2Mosnier, I, Cyna-Gorse, F, Grayeli, AB, Fraysse, B, Martin, C, Robier, A et al. Management of cholesterol granulomas of the petrous apex based on clinical and radiologic evaluation. Otol Neurotol 2002;23:522–8
3Brackmann, DE, Toh, EH.Surgical management of petrous apex cholesterol granulomas. Otol Neurotol 2002;23:529–33
4Sanna, M, Dispenza, F, Mathur, N, De Stefano, A, De Donato, G.Otoneurological management of petrous apex cholesterol granulomas. Am J Otolaryngol 2009;30:407–14
5Kimura, R, Perlman, HB.Arterial obstruction of the labyrinth. Part I. Cochlear changes. Ann Otol Rhinol Laryngol 1958;67:540
6Keithley, EM, Chen, M-C, Linthicum, F.Clinical diagnoses associated with histologic findings of fibrotic tissue and new bone in the inner ear. Laryngoscope 1998;108:8791

Keywords

Petrous apex cholesterol granuloma: pictorial review of radiological considerations in diagnosis and surgical histopathology

  • M Hoa (a1) (a2), J W House (a1) (a2), F H Linthicum (a2) and J L Go (a3)

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