Endoscopic endonasal approach to cholesterol granulomas of the petrous apex: a series of 17 patients

Clinical article

Alessandro PaluzziDepartments of Neurological Surgery and

Search for other papers by Alessandro Paluzzi in
Current site
Google Scholar
PubMed
Close
 M.D., F.R.C.S.(SN)
,
Paul GardnerDepartments of Neurological Surgery and

Search for other papers by Paul Gardner in
Current site
Google Scholar
PubMed
Close
 M.D.
,
Juan C. Fernandez-MirandaDepartments of Neurological Surgery and

Search for other papers by Juan C. Fernandez-Miranda in
Current site
Google Scholar
PubMed
Close
 M.D.
,
Carlos D. Pinheiro-NetoOtolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

Search for other papers by Carlos D. Pinheiro-Neto in
Current site
Google Scholar
PubMed
Close
 M.D., Ph.D.
,
Tiago Fernando ScopelOtolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

Search for other papers by Tiago Fernando Scopel in
Current site
Google Scholar
PubMed
Close
 M.D.
,
Maria KoutourousiouDepartments of Neurological Surgery and

Search for other papers by Maria Koutourousiou in
Current site
Google Scholar
PubMed
Close
 M.D.
, and
Carl H. SnydermanOtolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

Search for other papers by Carl H. Snyderman in
Current site
Google Scholar
PubMed
Close
 M.D., M.B.A.
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $45.00
USD  $515.00
USD  $612.00
Print or Print + Online Sign in

Object

The aim of this study was to report the results in a consecutive series of patients who had undergone an endoscopic endonasal approach (EEA) for drainage of a petrous apex cholesterol granuloma (CG).

Methods

Seventeen cases with a confirmed diagnosis of petrous apex CG were identified from a database of more than 1600 patients who had undergone an EEA to skull base lesions at the authors' institution in the period from 1998 to 2011. Clinical outcomes were reviewed and compared with those in previous studies of open approaches.

Results

Nine patients underwent a transclival approach and 8 patients underwent a combined transclival and infrapetrous approach. A Silastic stent was used in 11 patients (65%), a miniflap in 4 (24%), and a simple marsupialization of the cyst in 3 (18%). All symptomatic patients had partial or complete improvement of their symptoms postoperatively and at the follow-up (mean follow-up 20 months, range 3–67 months). Complications developed in 3 patients (18%) including epistaxis, chronic serous otitis media, eye dryness, and a transient sixth cranial nerve palsy. Two patients (12%) had a symptomatic recurrence of the cyst requiring repeat endoscopic endonasal drainage. There were no instances of internal carotid artery injuries, CSF leaks, or new hearing loss. The mean postoperative hospital stay was 2 days (range 0.7–4.6 days). These results were comparable with those in previous studies of open approaches to petrous apex CGs.

There was a strong correlation between the size of the cyst and the type of approach chosen (Rpb [point biserial correlation coefficient] = +0.67, p = 0.003359) and a very strong correlation between the degree of medial extension (defined by the V-angle) and the choice of approach (Rpb = +0.81, p < 0.0001). Based on these observations, the authors developed an algorithm for guiding the choice of the most appropriate route of drainage.

Conclusions

The EEA is a safe and effective alternative to traditional open approaches to petrous apex CGs.

  • Collapse
  • Expand
  • 1

    Bockmühl U, , Khalil HS, & Draf W: Clinicoradiological and surgical considerations in the treatment of cholesterol granuloma of the petrous pyramid. Skull Base 15:263268, 2005

    • Search Google Scholar
    • Export Citation
  • 2

    Bootz F, , Keiner S, , Schulz T, , Scheffler B, & Seifert V: Magnetic resonance imaging—guided biopsies of the petrous apex and petroclival region. Otol Neurotol 22:383388, 2001

    • Search Google Scholar
    • Export Citation
  • 3

    Brackmann DE, & Toh EH: Surgical management of petrous apex cholesterol granulomas. Otol Neurotol 23:529533, 2002

  • 4

    Brodkey JA, , Robertson JH, , Shea JJ III, & Gardner G: Cholesterol granulomas of the petrous apex: combined neurosurgical and otological management. J Neurosurg 85:625633, 1996

    • Search Google Scholar
    • Export Citation
  • 5

    Cristante L, & Puchner MA: A keyhole middle fossa approach to large cholesterol granulomas of the petrous apex. Surg Neurol 53:6471, 2000

    • Search Google Scholar
    • Export Citation
  • 6

    Dhanasekar G, & Jones NS: Endoscopic trans-sphenoidal removal of cholesterol granuloma of the petrous apex: case report and literature review. J Laryngol Otol 125:169172, 2011

    • Search Google Scholar
    • Export Citation
  • 7

    Eisenberg MB, , Haddad G, & Al-Mefty O: Petrous apex cholesterol granulomas: evolution and management. J Neurosurg 86:822829, 1997

  • 8

    Fucci MJ, , Alford EL, , Lowry LD, , Keane WM, & Sataloff RT: Endoscopic management of a giant cholesterol cyst of the petrous apex. Skull Base Surg 4:5258, 1994

    • Search Google Scholar
    • Export Citation
  • 9

    Gallia G, & Reh D: Expanded endonasal endoscopic approach to the petrous apex. Otolaryngol Head Neck Surg 143:Suppl 2 P281P282, 2010. (Poster) (http://oto.sagepub.com/content/143/2_suppl/P281.3.full) [Accessed November 18, 2011]

    • Search Google Scholar
    • Export Citation
  • 10

    Georgalas C, , Kania R, , Guichard JP, , Sauvaget E, , Tran Ba Huy P, & Herman P: Endoscopic transsphenoidal surgery for cholesterol granulomas involving the petrous apex. Clin Otolaryngol 33:3842, 2008

    • Search Google Scholar
    • Export Citation
  • 11

    Griffith AJ, & Terrell JE: Transsphenoid endoscopic management of petrous apex cholesterol granuloma. Otolaryngol Head Neck Surg 114:9194, 1996

    • Search Google Scholar
    • Export Citation
  • 12

    Jaberoo MC, , Hassan A, , Pulido MA, & Saleh HA: Endoscopic endonasal approaches to management of cholesterol granuloma of the petrous apex. Skull Base 20:375379, 2010

    • Search Google Scholar
    • Export Citation
  • 13

    Jackler RK, & Cho M: A new theory to explain the genesis of petrous apex cholesterol granuloma. Otol Neurotol 24:96106, 2003

  • 14

    Jaramillo M, & Windle-Taylor PCJ: Large cholesterol granuloma of the petrous apex treated via subcochlear drainage. J Laryngol Otol 115:10051009, 2001

    • Search Google Scholar
    • Export Citation
  • 15

    Mattox DE: Endoscopy-assisted surgery of the petrous apex. Otolaryngol Head Neck Surg 130:229241, 2004

  • 16

    Montgomery WW: Cystic lesions of the petrous apex: transsphenoid approach. Ann Otol Rhinol Laryngol 86:429435, 1977

  • 17

    Moore KR, , Harnsberger HR, , Shelton C, & Davidson HC: ‘Leave me alone’ lesions of the petrous apex. AJNR Am J Neuroradiol 19:733738, 1998

    • Search Google Scholar
    • Export Citation
  • 18

    Mosnier I, , Cyna-Gorse F, , Grayeli AB, , Fraysse B, , Martin C, & Robier A, et al.: Management of cholesterol granulomas of the petrous apex based on clinical and radiologic evaluation. Otol Neurotol 23:522528, 2002

    • Search Google Scholar
    • Export Citation
  • 19

    Nager GT, & Vanderveen TS: Cholesterol granuloma involving the temporal bone. Ann Otol Rhinol Laryngol 85:204209, 1976

  • 20

    Oyama K, , Ikezono T, , Tahara S, , Shindo S, , Kitamura T, & Teramoto A: Petrous apex cholesterol granuloma treated via the endoscopic transsphenoidal approach. Acta Neurochir (Wien) 149:299302, 2007

    • Search Google Scholar
    • Export Citation
  • 21

    Prabhu K, , Kurien M, & Chacko AG: Endoscopic transsphenoidal approach to petrous apex cholesterol granulomas. Br J Neurosurg 24:688691, 2010

    • Search Google Scholar
    • Export Citation
  • 22

    Presutti L, , Villari D, & Marchioni D: Petrous apex cholesterol granuloma: transsphenoid endoscopic approach. J Laryngol Otol 120:e20, 2006

    • Search Google Scholar
    • Export Citation
  • 23

    Sanna M, , Dispenza F, , Mathur N, , De Stefano A, & De Donato G: Otoneurological management of petrous apex cholesterol granuloma. Am J Otolaryngol 30:407414, 2009

    • Search Google Scholar
    • Export Citation
  • 24

    Snyderman CH, , Kassam AB, , Carrau R, & Mintz A: Endoscopic approaches to the petrous apex. Op Tech Otolaryngol 17:168173, 2006

  • 25

    Zanation AM, , Snyderman CH, , Carrau RL, , Gardner PA, , Prevedello DM, & Kassam AB: Endoscopic endonasal surgery for petrous apex lesions. Laryngoscope 119:1925, 2009

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 848 213 11
Full Text Views 366 46 2
PDF Downloads 266 58 3
EPUB Downloads 0 0 0