scholarly journals Nasopharyngeal Approach to a Cholesterol Granuloma of the Petrous Apex

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.

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

2013 ◽  
Vol 127 (4) ◽  
pp. 339-348 ◽  
Author(s):  
M Hoa ◽  
J W House ◽  
F H Linthicum ◽  
J L Go
Keyword(s):  
Differential Diagnosis ◽  
Surgical Management ◽  
Fibrous Tissue ◽  
Tissue Reaction ◽  
Petrous Apex ◽  
Cholesterol Granuloma ◽  
Surgical Drainage ◽  
Radiological Features ◽  
Pictorial Review ◽  
Appropriate Treatment

AbstractBackground: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.

scholarly journals Paraganglioma Presenting as Cholesterol Granuloma of the Petrous Apex

2013 ◽  
Vol 92 (9) ◽  
pp. 430-434
Author(s):  
Selena E. Heman-Ackah ◽  
Tina C. Huang
Keyword(s):  
Hearing Loss ◽  
Signs And Symptoms ◽  
Initial Presentation ◽  
Petrous Apex ◽  
Cholesterol Granuloma ◽  
Pulsatile Tinnitus ◽  
Glomus Jugulare Tumor ◽  
Glomus Jugulare ◽  
Potential Association

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.

scholarly journals Endoscopic Endonasal Management of Recurrent Petrous Apex Cholesterol Granuloma

2012 ◽  
Vol 73 (03) ◽  
pp. 190-196 ◽  
Author(s):  
Nancy McLaughlin ◽  
Daniel Kelly ◽  
Daniel Prevedello ◽  
Kiarash Shahlaie ◽  
Ricardo Carrau ◽  
...  
Keyword(s):  
Petrous Apex ◽  
Cholesterol Granuloma ◽  
Endoscopic Endonasal

Endoscopic Endonasal Approach for Petrous Apex Cholesterol Granuloma: Cases Report and Review

2014 ◽  
Vol 75 (S 02) ◽  
Author(s):  
Mohammad Samadian ◽  
Nader Dilmaghani ◽  
Habibollah Moghaddasi ◽  
Mohsen Vazirnezami ◽  
Reza Jabbari ◽  
...  
Keyword(s):  
Petrous Apex ◽  
Cholesterol Granuloma ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal

Endoscopic Endonasal Petrosectomy for Resection of Giant Petrous Apex Cholesterol Granuloma with Posterior and Middle Fossa Extension: Case Report

Skull Base ◽  
2009 ◽  
Vol 19 (01) ◽  
Author(s):  
Juan Fernandez-Miranda ◽  
Victor Morera ◽  
Rick Madhok ◽  
Daniel Prevedello ◽  
Paul Gardner ◽  
...  
Keyword(s):  
Case Report ◽  
Petrous Apex ◽  
Cholesterol Granuloma ◽  
Middle Fossa ◽  
Endoscopic Endonasal

scholarly journals Novel Application of Steroid Eluting Stent in Petrous Apex Cholesterol Granuloma

2018 ◽  
Vol 80 (05) ◽  
pp. 500-504
Author(s):  
Kevin J. Choi ◽  
David W. Jang ◽  
Ali R. Zomorodi ◽  
Patrick J. Codd ◽  
Allan Friedman ◽  
...  
Keyword(s):  
Mometasone Furoate ◽  
Long Term Results ◽  
Petrous Apex ◽  
Cholesterol Granuloma ◽  
Tertiary Referral ◽  
Endoscopic Endonasal ◽  
Tertiary Referral Center ◽  
Primary Management

Abstract Objective This study describes the safety and efficacy of mometasone furoate eluting stents in the management of petrous apex cholesterol granuloma approached through an endonasal endoscopic route and assesses the restenosis rate. Methods Consecutive patients undergoing endoscopic endonasal marsupialization of a petrous apex cholesterol granuloma at a tertiary referral center who had a mometasone furoate eluting stent placed intraoperatively were reviewed in a retrospective fashion. Postoperative endoscopy was used to determine success of surgery and stenting. Results Five patients were included in the study, three were primary cases and two patients had revision surgeries performed. The steroid eluting stent was placed successfully and safely in all patients with no dural or vascular injuries. The average follow-up duration was 10.6 months. There was no restenosis in three patients and one patient had an immediate restenosis that was debrided in clinic (revision case). This was patent at the 16 months follow-up. One patient also developed stenosis, 4 months after surgery due to sphenoid sinusitis. Conclusion Mometasone furoate eluting stents are safe and effective in the primary management of petrous apex cholesterol granuloma. Further studies are needed to assess their efficacy in revision cases and for long term results.

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

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.

Extirpation of Recurrent Petrous Apex Cholesterol Granuloma Through the Zygomatic Approach: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Mark Eisenberg ◽  
Walid Ibn Essayed ◽  
Ossama Al-Mefty
Keyword(s):  
Short Distance ◽  
Petrous Apex ◽  
Cholesterol Granuloma ◽  
Middle Fossa ◽  
Resonance Imaging ◽  
Endoscopic Endonasal ◽  
Middle Fossa Approach ◽  
Weighted Magnetic Resonance Imaging ◽  
Year 2000 ◽  
Air Cells

Abstract Petrous apex cholesterol granulomas are believed to result from blockage of the normal aeration of the petrous air cells, resulting in a repetitive cycle of mucosal engorgement, hemorrhage, and granuloma formation.1 The lesion usually progressively expands causing compressive symptoms. The thick granulomatous wall envelopes various ages of breakdown products, including a cholesterol-containing fluid, which is typically hyperintense on T1 and T2 weighted magnetic resonance imaging. Drainage procedures, regardless of the route (endoscopic, endonasal, or transtemporal), with or without stenting or marsupialization, will only temporarily drain this cholesterol-containing fluid, with consequently frequent recurrences.2-5 A total exoneration of the granuloma and obliteration of the cavity with vascularized tissue will assure a more durable outcome.1 The extradural zygomatic/middle fossa approach provides a short distance to the petrous apex and is purely extradural. By sectioning the zygoma, temporal lobe retraction is avoided.6 We present a case of a 29-yr-old male who presented in the year 2000 with progression of a left petrous apex cholesterol granuloma despite 2 previous drainage and stenting procedures.  The patient consented for surgery and photo publication. Images in video at 2:41 © JNSPG, republished from Eisenberg et al1 with permission.

Comparative analysis of the anterior transpetrosal approach with the endoscopic endonasal approach to the petroclival region

2016 ◽  
Vol 125 (5) ◽  
pp. 1171-1186 ◽  
Author(s):  
Jun Muto ◽  
Daniel M. Prevedello ◽  
Leo F. S. Ditzel Filho ◽  
Ing Ping Tang ◽  
Kenichi Oyama ◽  
...  
Keyword(s):  
Abducens Nerve ◽  
Direct Access ◽  
Petrous Apex ◽  
Horizontal Line ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Petroclival Region ◽  
Advantages And Disadvantages ◽  
Anterior Transpetrosal Approach

OBJECTIVE The endoscopic endonasal approach (EEA) offers direct access to midline skull base lesions, and the anterior transpetrosal approach (ATPA) stands out as a method for granting entry into the upper and middle clival areas. This study evaluated the feasibility of performing EEA for tumors located in the petroclival region in comparison with ATPA. METHODS On 8 embalmed cadaver heads, EEA to the petroclival region was performed utilizing a 4-mm endoscope with either 0° or 30° lenses, and an ATPA was performed under microscopic visualization. A comparison was executed based on measurements of 5 heads (10 sides). Case illustrations were utilized to demonstrate the advantages and disadvantages of EEA and ATPA when dealing with petroclival conditions. RESULTS Extradurally, EEA allows direct access to the medial petrous apex, which is limited by the petrous and paraclival internal carotid artery (ICA) segments laterally. The ATPA offers direct access to the petrous apex, which is blocked by the petrous ICA and abducens nerve inferiorly. Intradurally, the EEA allows a direct view of the areas medial to the cisternal segment of cranial nerve VI with limited lateral exposure. ATPA offers excellent access to the cistern between cranial nerves III and VIII. The quantitative analysis demonstrated that the EEA corridor could be expanded laterally with an angled drill up to 1.8 times wider than the bone window between both paraclival ICA segments. CONCLUSIONS The midline, horizontal line of the petrous ICA segment, paraclival ICA segment, and the abducens nerve are the main landmarks used to decide which approach to the petroclival region to select. The EEA is superior to the ATPA for accessing lesions medial or caudal to the abducens nerve, such as chordomas, chondrosarcomas, and midclival meningiomas. The ATPA is superior to lesions located posterior and/or lateral to the paraclival ICA segment and lesions with extension to the middle fossa and/or infratemporal fossa. The EEA and ATPA are complementary and can be used independently or in combination with each other in order to approach complex petroclival lesions.

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