Endoscope-Assisted Transmastoid Infralabyrinthine Drainage of Petrous Apex Cholesterol Granuloma

Abstract

We report a case of a transmastoid endoscopic-assisted decompression of cholesterol granuloma within the petrous apex in an 18-year-old woman. This patient was referred as an outpatient to our neuro-otology practice. The patient had presented with long-standing history of left-sided pulsatile tinnitus, aural fullness, and headaches. Following thorough clinical evaluation, imaging revealed a large left-sided petrous apex cholesterol granuloma. A transmastoid infralabyrinthine approach was chosen due to the anterior and inferior location lesion, in addition to preserving the cochlear and vestibular organs. Intraoperatively, access was limited due to the sigmoid sinus posteriorly and jugular bulb inferiorly. An angled 30-degree otologic endoscope was introduced, and the cholesterol granuloma cyst was identified. A 21-gauge Angiocath was adapted and employed to enter the diseased air cells. Suction was applied to the Angiocath, and fluid was drained from the involved cells. A stent was then placed endoscopically. Postoperatively, the patient showed signs of clinical improvement with resolution of the aural fullness, tinnitus, and headaches.