Endoscopic balloon dilation as an adjunct to extended endoscopic approaches to the skull base

Case report

Restricted access

Cholesterol granulomas (CGs) are benign, expanding cystic lesions surrounded by a thick fibrous capsule and filled with fluid, formed by the degradation of blood elements. The goal of surgery is to open the granuloma widely, creating a well-drained cavity. The endonasal endoscopic approach for this extradural lesion is a minimal access method for surgical removal or fenestration. The role of balloon dilation in creating a wide fenestration has not been previously described.

The authors describe a patient with a recurrent petrous apex CG who underwent an endoscopic, endonasal, transmaxillary transpterygoid approach to the petrous apex. A balloon sinuplasty catheter was used to dilate the surgical fenestration to maintain continued patency.

The authors report on their first experience using balloon dilation combined with endoscopic drainage of the petrous apex. The excellent surgical outcome of this minimally invasive technique holds promise for future endonasal approaches to the middle cranial fossa.

Abbreviation used in this paper:CG = cholesterol granuloma.

Article Information

Address correspondence to: Theodore H. Schwartz, M.D., Department of Neurological Surgery, Weill Cornell Medical College, 525 East 68th Street, Box #99, New York, New York 10065. email: schwarh@med.cornell.edu.

Please include this information when citing this paper: published online March 9, 2012; DOI: 10.3171/2012.2.JNS111815.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Axial postcontrast T1-weighted MR image demonstrating a cystic CG of the right petrous apex.

  • View in gallery

    Endoscopic view showing a balloon catheter inserted into the right petrous apex after accessing the CG.

  • View in gallery

    Six-month postoperative axial postcontrast T1-weighted MR image demonstrating wide drainage of the right petrous apex into the sphenoid sinus.

  • View in gallery

    Illustration demonstrating the location of the intrapetrous carotid artery (IPC) and its association with the eustachian tube (ET). The drainage corridor of the petrous apex (PDC) appears superior to the eustachian tube. Printed with the permission of V. K. Anand, 2012.

References

  • 1

    Batra PSRyan MWSindwani RMarple BF: Balloon catheter technology in rhinology: reviewing the evidence. Laryngoscope 121:2262322011

    • Search Google Scholar
    • Export Citation
  • 2

    Bolger WEBrown CLChurch CAGoldberg ANKaranfilov BKuhn FA: Safety and outcomes of balloon catheter sinusotomy: a multicenter 24-week analysis in 115 patients. Otolaryngol Head Neck Surg 137:10202007

    • Search Google Scholar
    • Export Citation
  • 3

    Bolger WEVaughan WC: Catheter-based dilation of the sinus ostia: initial safety and feasibility analysis in a cadaver model. Am J Rhinol 20:2902942006

    • Search Google Scholar
    • Export Citation
  • 4

    Brackmann DEToh EH: Surgical management of petrous apex cholesterol granulomas. Otol Neurotol 23:5295332002

  • 5

    Brodkey JARobertson JHShea JJ IIIGardner G: Cholesterol granulomas of the petrous apex: combined neurosurgical and otological management. J Neurosurg 85:6256331996

    • Search Google Scholar
    • Export Citation
  • 6

    Brown CLBolger WE: Safety and feasibility of balloon catheter dilation of paranasal sinus ostia: a preliminary investigation. Ann Otol Rhinol Laryngol 115:2933012006

    • Search Google Scholar
    • Export Citation
  • 7

    Cristante LPuchner MA: A keyhole middle fossa approach to large cholesterol granulomas of the petrous apex. Surg Neurol 53:64712000

    • Search Google Scholar
    • Export Citation
  • 8

    DiNardo LJPippin GWSismanis A: Image-guided endoscopic transsphenoidal drainage of select petrous apex cholesterol granulomas. Otol Neurotol 24:9399412003

    • Search Google Scholar
    • Export Citation
  • 9

    Eisenberg MBHaddad GAl-Mefty O: Petrous apex cholesterol granulomas: evolution and management. J Neurosurg 86:8228291997

  • 10

    Fisch U: Infratemporal fossa approach to tumours of the temporal bone and base of the skull. J Laryngol Otol 92:9499671978

  • 11

    Gianoli GJAmedee RG: Hearing results in surgery for primary petrous apex lesions. Otolaryngol Head Neck Surg 111:2502571994

  • 12

    Giddings NABrackmann DEKwartler JA: Transcanal infracochlear approach to the petrous apex. Otolaryngol Head Neck Surg 104:29361991

    • Search Google Scholar
    • Export Citation
  • 13

    Goldofsky EHoffman RAHolliday RACohen NL: Cholesterol cysts of the temporal bone: diagnosis and treatment. Ann Otol Rhinol Laryngol 100:1811871991

    • Search Google Scholar
    • Export Citation
  • 14

    House JLBrackmann DE: Cholesterol granuloma of the cerebellopontine angle. Arch Otolaryngol 108:5045061982

  • 15

    Levine HLSertich AP IIHoisington DRWeiss RLPritikin J: Multicenter registry of balloon catheter sinusotomy outcomes for 1,036 patients. Ann Otol Rhinol Laryngol 117:2632702008

    • Search Google Scholar
    • Export Citation
  • 16

    Muckle RPDe la Cruz ALo WM: Petrous apex lesions. Am J Otol 19:2192251998

  • 17

    Ramadan HH: Safety and feasibility of balloon sinuplasty for treatment of chronic rhinosinusitis in children. Ann Otol Rhinol Laryngol 118:1611652009

    • Search Google Scholar
    • Export Citation
  • 18

    Royer MCPensak ML: Cholesterol granulomas. Curr Opin Otolaryngol Head Neck Surg 15:3193222007

  • 19

    Sanna MDispenza FMathur NDe Stefano ADe Donato G: Otoneurological management of petrous apex cholesterol granuloma. Am J Otolaryngol 30:4074142009

    • Search Google Scholar
    • Export Citation
  • 20

    Thedinger BANadol JB JrMontgomery WWThedinger BSGreenberg JJ: Radiographic diagnosis, surgical treatment, and long-term follow-up of cholesterol granulomas of the petrous apex. Laryngoscope 99:8969071989

    • Search Google Scholar
    • Export Citation
  • 21

    Welch KCStankiewicz JA: Application of minimally invasive endoscopic sinus surgery techniques. Otolaryngol Clin North Am 43:565578ix:2010

    • Search Google Scholar
    • Export Citation
  • 22

    Wittkopf MLBecker SSDuncavage JARussell PT: Balloon sinuplasty for the surgical management of immunocompromised and critically ill patients with acute rhinosinusitis. Otolaryngol Head Neck Surg 140:5965982009

    • Search Google Scholar
    • Export Citation

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 132 132 7
Full Text Views 112 112 0
PDF Downloads 168 168 0
EPUB Downloads 0 0 0

PubMed

Google Scholar