Endoscopic Transsphenoidal Drainage of a Big Petrous Apex Cholesterol Granuloma

Abstract

Introduction: Petrous apex cholesterol granulomas are the most commonly seen benign tumors that occur at the pneumatized cells in this region. They occur as a foreign body granulomatous reaction to cholesterol crystals, which are the end products of hemosiderin arising from erythrocyte breakdown after a local hemorrhage. Their management is principally watchful waiting, as long as they are not symptomatic. However, because of their expansive pressure on adjacent structures, giant cholesterol granulomas cause neurological symptoms, such as headache or cranial nerve deficits, rather than otologic ones. Once surgery is indicated in this difficult-to-reach area, appropriate treatment is controversial; it is a choice between traditionally used surgical drainage procedures (infralabyrinthine, infracochlear) and approaches that aim for total removal (transtemporal, extended translabyrinthine, transcochlear, transotic). These treatment modalities have, respectively, either high recurrence rates or risk high morbidity because of exposing and removing critical areas and structures. In cases with anatomical features suitable for transsphenoidal surgery, the endonasal endoscopic approach promises a reasonable and durable drainage pathway to the nasal cavity.