Paraganglioma Presenting as Cholesterol Granuloma of the Petrous Apex

We report the unique finding of a petrous apex cholesterol granuloma associated with a paraganglioma, also known as a glomus jugulare tumor, in a 52-year-old woman who presented to our department with pulsatile tinnitus, hearing loss, aural fullness, and disequilibrium. She had been treated for a petrous apex cholesterol granuloma 20 years earlier, at which time she had undergone drainage of the granuloma via subtotal petrous apicectomy. When she came to our facility approximately 20 years later, she had signs and symptoms consistent with a jugular paraganglioma, which was likely to have been present at the time of her initial presentation for the cholesterol granuloma. In fact, microscopic bleeding from the paraganglioma might have led to the formation of the cholesterol granuloma. The metachronous presentation of these two entities, which to our knowledge has not been reported previously in the literature, indicates the potential association of paragangliomas with the formation of cholesterol granulomas of the petrous apex.

Download Full-text

Depression, Palpitations, and Unilateral Pulsatile Tinnitus due to a Dopamine-secreting Glomus Jugulare Tumor

The American Journal of Medicine ◽

10.1016/s0002-9343(98)00019-9 ◽

1998 ◽

Vol 104 (3) ◽

pp. 310-311 ◽

Cited By ~ 6

Author(s):

Richard W Troughton ◽

Darryl Fry ◽

Rob S Allison ◽

M.Gary Nicholls

Keyword(s):

Pulsatile Tinnitus ◽

Glomus Jugulare Tumor ◽

Glomus Jugulare

Download Full-text

Complete Recovery of Sensorineural Hearing Loss Following Endoscopic Transsphenoidal Surgery for a Petrous Apex Cholesterol Granuloma: Case Report

American Journal of Case Reports ◽

10.12659/ajcr.913964 ◽

2019 ◽

Vol 20 ◽

pp. 335-339

Author(s):

Aleksandar Radonjic ◽

Ioana D. Moldovan ◽

Shaun J. Kilty ◽

David R. Schramm ◽

Fahad Alkherayf

Keyword(s):

Hearing Loss ◽

Case Report ◽

Sensorineural Hearing Loss ◽

Transsphenoidal Surgery ◽

Complete Recovery ◽

Sensorineural Hearing ◽

Petrous Apex ◽

Cholesterol Granuloma ◽

Endoscopic Transsphenoidal Surgery

Download Full-text

Combined transmastoid middle fossa approach for giant cholesterol granuloma of the petrous apex: technique for “dual exhaust” drainage

Neurosurgical FOCUS ◽

10.3171/2014.v1.focus13417 ◽

2014 ◽

Vol 36 (v1supplement) ◽

pp. 1

Author(s):

James K. Liu ◽

Robert W. Jyung

Keyword(s):

Hearing Loss ◽

Facial Nerve ◽

Cyst Wall ◽

Petrous Apex ◽

Cholesterol Granuloma ◽

Middle Fossa ◽

Catheter Drainage ◽

Middle Fossa Approach ◽

Air Cells ◽

Cyst Cavity

Cholesterol granulomas are cystic lesions that typically arise in the petrous apex as a result of an inflammatory giant-cell reaction to cholesterol crystal deposits that are formed when normal aeration and drainage of temporal bone air cells become occluded resulting in transudation of blood into the petrous air cells. Surgical strategies include simple cyst decompression, radical excision of the cyst wall, or fenestration and drainage with silastic tubing. The authors present a giant cholesterol granuloma compressing the cerebellopontine angle and brainstem in a 35 year-old male who presented with progressive facial nerve weakness, sensorineural hearing loss, and vertigo. A combined transmastoid middle fossa extradural approach was performed to remove the cyst contents and decompress the brain-stem. A near total excision of the cyst wall was achieved with a small remnant adherent to the posterior fossa dura. Two separate silastic catheters were placed into the cyst cavity to provide “dual exhaust” drainage. One catheter drained the cyst cavity into the sphenoid sinus via a window made in the anteromedial triangle between V1 and V2. The second catheter drained the cyst cavity into the mastoidectomy cavity and middle ear. Postoperative MRI demonstrated regression of the cyst and excellent decompression of the brainstem. The patient experienced return of normal facial nerve function while hearing loss remained unchanged. He remained free of recurrence at 4 years postoperatively. The theoretical advantages of cyst wall removal combined with dual catheter drainage are longer term patency of cyst drainage and decrease of cyst recurrence. In this operative video atlas report, we describe the step-by-step technique and illustrate the operative nuances and surgical pearls to safely and efficiently perform the “dual exhaust” catheter drainage and resection of a giant cholesterol granuloma via a combined transmastoid middle fossa approach.The video can be found here: http://youtu.be/iZpYBP26ghA.

Download Full-text

Nasopharyngeal Approach to a Cholesterol Granuloma of the Petrous Apex

Ear Nose & Throat Journal ◽

10.1177/01455613211028074 ◽

2021 ◽

pp. 014556132110280

Author(s):

Sara Raquel Azevedo ◽

Gonçalo Mendes ◽

Miguel Bebiano Coutinho ◽

Cecília Almeida e Sousa

Keyword(s):

Hearing Loss ◽

Surgical Management ◽

Petrous Apex ◽

Surgical Approaches ◽

Cholesterol Granuloma ◽

Endoscopic Endonasal ◽

Cholesterol Crystals ◽

Inflammatory Lesions ◽

Advantages And Disadvantages

Cholesterol granulomas are rare cystic inflammatory lesions characterized by the formation of cholesterol crystals. They are the most prevalent lesions of the petrous apex and when symptomatic, hearing loss, vertigo, tinnitus, headache, and facial pathology can be present. Surgical management is recommended in symptomatic patients. There are different surgical approaches to cholesterol granulomas. The aim of this article is to present and describe an endoscopic endonasal nasopharyngeal approach to a cholesterol granuloma and explain the advantages and disadvantages.

Download Full-text

Superior petrosal sinus causing superior canal dehiscence syndrome

The Journal of Laryngology & Otology ◽

10.1017/s0022215117001013 ◽

2017 ◽

Vol 131 (7) ◽

pp. 593-597 ◽

Cited By ~ 3

Author(s):

S M D Schneiders ◽

J W Rainsbury ◽

E F Hensen ◽

R M Irving

Keyword(s):

Computed Tomography ◽

Hearing Loss ◽

Clinical Signs ◽

Signs And Symptoms ◽

Pulsatile Tinnitus ◽

Computed Tomography Imaging ◽

Tomography Imaging ◽

Superior Canal Dehiscence ◽

Superior Petrosal Sinus ◽

Canal Dehiscence

AbstractObjective:To determine signs and symptoms for superior canal dehiscence syndrome caused by the superior petrosal sinus.Methods:A review of the English-language literature on PubMed and Embase databases was conducted, in addition to a multi-centre case series report.Results:The most common symptoms of 17 patients with superior petrosal sinus related superior canal dehiscence syndrome were: hearing loss (53 per cent), aural fullness (47 per cent), pulsatile tinnitus (41 per cent) and pressure-induced vertigo (41 per cent). The diagnosis was made by demonstration of the characteristic bony groove of the superior petrosal sinus and the ‘cookie bite’ out of the superior semicircular canal on computed tomography imaging.Conclusion:Pulsatile tinnitus, hearing loss, aural fullness and pressure-induced vertigo are the most common symptoms in superior petrosal sinus related superior canal dehiscence syndrome. Compared to superior canal dehiscence syndrome caused by the more common apical location of the dehiscence, pulsatile tinnitus and exercise-induced vertigo are more frequent, while sound-induced vertigo and autophony are less frequent. There is, however, considerable overlap between the two subtypes. The distinction cannot as yet be made on clinical signs and symptoms alone, and requires careful analysis of computed tomography imaging.

Download Full-text

Extradural Transjugular Transsigmoid Approach with High Cervical Exposure for Glomus Jugulare Tumor

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0039-1695057 ◽

2019 ◽

Vol 80 (S 04) ◽

pp. S382-S384

Author(s):

Ken Matsushima ◽

Michihiro Kohno ◽

Takao Hashimoto ◽

Hitoshi Izawa ◽

Yujiro Tanaka ◽

...

Keyword(s):

Facial Nerve ◽

Temporal Bone ◽

Hemifacial Spasm ◽

Cervical Region ◽

Cerebrospinal Fluid Leakage ◽

Pulsatile Tinnitus ◽

Glomus Jugulare Tumor ◽

Glomus Jugulare ◽

Brainstem Response ◽

High Cervical

AbstractSurgical removal of glomus jugulare tumors is challenging owing to the complex anatomy of the temporal bone and craniocervical region, aggressive tumor invasion into the nearby structures, and their hypervascularity. However, recent advances in skull base techniques, intraoperative neuromonitoring, and radiological interventions have enabled their relatively safe resection, while giving priority to functional preservation. This video demonstrates a case of a glomus jugulare tumor treated by the extradural transjugular transsigmoid approach with high-cervical exposure and tympamoplasty, after preoperative embolization. A 47-year-old woman presented with progressive hearing disturbance, pulsatile tinnitus, and hemifacial spasm. Neuroimaging displayed a hypervascular tumor occupying the temporal bone, extending to the cervical region through the jugular foramen, and to the external auditory canal. Preoperative feeder occlusion was successfully performed without any additional symptoms, while carefully evaluating the provocative test. Near-total resection of the tumor was achieved through the transjugular transsigmoid approach with high-cervical exposure under detailed neuromonitoring, including continuous facial nerve monitoring and auditory brainstem response. In this patient, in whom the tumor did not invade intradurally and the sigmoid sinus was already occluded preoperatively, the sinus was managed only by coagulation, to avoid unnecessary dural opening and the risk of cerebrospinal fluid leakage. Anterior facial nerve rerouting was not required since the tumor removal was accomplished through the corridor above and below the fallopian bridge. The patient had no new neurological deficits, and her pulsatile tinnitus and hemifacial spasm disappeared after the surgery. Her hearing disturbance improved postoperatively.The link to the video can be found at: https://youtu.be/gqf3dxHlv_0.

Download Full-text

Cholesterol Granuloma Cyst of the Petrous Apex

Ear Nose & Throat Journal ◽

10.1177/014556139607500711 ◽

1996 ◽

Vol 75 (7) ◽

pp. 425-429 ◽

Cited By ~ 5

Author(s):

Jon E. Isaacson ◽

Aristides Sismanis

Keyword(s):

Cerebellopontine Angle ◽

Signs And Symptoms ◽

Mass Lesion ◽

Petrous Apex ◽

Cholesterol Granuloma ◽

Review Of The Literature ◽

Management Algorithms

Cholesterol granuloma cyst of the petrous apex is an uncommon lesion and often presents a diagnostic and management dilemma to the otolaryngologist. Patients usually demonstrate signs and symptoms referable to a mass lesion of the cerebellopontine angle or brainstem. We present two cases of cholesterol granuloma cyst that were treated at our institution and discuss our diagnostic and management algorithms. Also included is a thorough review of the literature.

Download Full-text