Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-24T04:34:21.799Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  26 October 2010

G Dhanasekar  and
N S Jones
G Dhanasekar*
Affiliation:
Department of Otolaryngology/Head and Neck Surgery, Queen's Medical Centre, Nottingham, UK
N S Jones
Affiliation:
Department of Otolaryngology/Head and Neck Surgery, Queen's Medical Centre, Nottingham, UK
*
Address for correspondence: Mr G Dhanasekar, 6 Woodhayes Croft, Wolverhampton WV10 8PP, UK E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

Cholesterol GranulomaPetrous ApexSphenoidEndoscopic
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 125 , Issue 2 , February 2011 , pp. 169 - 172
Copyright
Copyright © JLO (1984) Limited 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

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

References

1Brackmann, DE, Toh, EH. Surgical management of petrous apex cholesterol granulomas. Otol Neurotol 2002;23:529–33CrossRefGoogle ScholarPubMed
2House, WF. Middle cranial fossa approach to the petrous pyramid. Arch Otolaryngol 1963;78:460–7CrossRefGoogle Scholar
3House, WF, Histelberger, WE. The transcochlear approach to the skull base. Arch Otolaryngol 1976;102:234–42CrossRefGoogle ScholarPubMed
4Haberkamp, TJ. Surgical anatomy of the transtemporal approaches to the petrous apex. Am J Otol 1997;18:501–6Google Scholar
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;19:106–11Google ScholarPubMed
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;33:38–42CrossRefGoogle ScholarPubMed
7Presutti, L, Villari, D, Marchioni, D. Petrous apex cholesterol granuloma: transsphenoid endoscopic approach. J Laryngol Otol 2006;120:e20. Epub 2006 May 15CrossRefGoogle ScholarPubMed
8DiNardo, LJ, Pippin, GW, Sismanis, A. Image-guided endoscopic transsphenoidal drainage of select petrous apex cholesterol granulomas. Otol Neurotol 2003;24:939–41CrossRefGoogle ScholarPubMed
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;57:165–9CrossRefGoogle ScholarPubMed
10Meyer, C. Fremdkorperperitonitis with the formation of riesenzellhaltigen Knotchen by encapsulation of cholesterol plaques [in German]. Zieglers Beitr 1893;13:76Google Scholar
11Manasse, P. About granulomas with Fremdkorperriesenzellen [in German]. Virchows Arch 1894;136:245CrossRefGoogle Scholar
12Wagner, D. Crystals and giant cell formation in Mittelohreitenungen [in German]. Ver Otol Ges 1904;16:138Google Scholar
13Beaumont, GD. Cholesterol granuloma. J Otolaryngol Aust 1967;2:28–35Google Scholar
14Hiraide, F, Inoye, T, Miyakogama, N. Experimental cholesterol granuloma. Histopathological and histochemical studies. Laryngol Otol 1982;96:491–501CrossRefGoogle ScholarPubMed
15Chao, TK. Cholesterol granuloma of the maxillary sinus. Eur Arch Otorhinolaryngol 2006;263:592–7CrossRefGoogle ScholarPubMed
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;99:896–907CrossRefGoogle ScholarPubMed
17Lo, WW, Solti-Bohmann, LG, Brackmann, DE, Gruskin, P. Cholesterol granuloma of the petrous apex: CT diagnosis. Radiology 1984;153:705–11CrossRefGoogle ScholarPubMed
18Goldofsky, E, Hoffman, RA, Holliday, RA, Cohen, NL. Cholesterol cysts of the temporal bone: diagnosis and treatment. Ann Otol Rhinol Laryngol 1991;100:181–6CrossRefGoogle ScholarPubMed
19Sabin, HI, Vordi, LT, Symon, L. Epidermoid cysts and cholesterol granulomas centered on the posterior fossa: twenty years of diagnosis and management. Neurosurgery 1987;21:793–805Google ScholarPubMed
20Montgomery, WW. Cystic lesions of the petrous apex: transsphenoidal approach. Ann Otol Rhinol Laryngol 1977;86:429–35CrossRefGoogle Scholar
21Fucci, MJ, Alford, EL, Lowry, LD. Endoscopic management of a giant cholesterol cyst of the petrous apex. Skull Base Surg 1994;41:52–8CrossRefGoogle Scholar
22Casiano, RR. Intraoperative image-guided technology. Arch Otolaryngol Head Neck Surg 1999;125:1275–8CrossRefGoogle Scholar
23Klimek, L, Mosges, G, Laborde, G, Korves, B. Computer-assisted image-guided surgery in pediatric skullbase procedures. J Pediatric Surg 1995;30:1673–6CrossRefGoogle ScholarPubMed
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;188:735–42CrossRefGoogle ScholarPubMed