Transsphenoidal and Infralabyrinthine Approach of the Petrous Apex Cholesterol Granuloma

Overview

Journal Eur Arch Otorhinolaryngol

Specialty Otorhinolaryngology

Date 2017 May 6

PMID 28474189

Citations 5

Authors

Karl-Ludwig Bruchhage

Barbara Wollenberg

Anke Leichtle

Affiliations

Soon will be listed here.

Abstract

Space-demanding or destructive changes in the petrous bone are often challenging differential diagnosis. Cholesterol granulomas of the petrous apex can clinically present in a combination of hearing loss, vertigo, tinnitus, chronic cephalgia, impairment of facial nerve function, neuralgic pain of the nervus trigeminus, or manifest diplopia by the nerve palsy of the nervus abducens. CT-morphologically cholesterol granulomas appear as soft-tissue density masses, which may display a discrete rim after intravenous administration of a contrast agent. The MRI, T1 as well as T2-weighted images show a strong signal in the area of the lesion. Depending on the individual anatomical conditions, the surgical access must be carefully chosen between transsphenoidal, transtemporal, infracochlear/-labyrinthine, or translabyrinthine. Here, we present the transsphenoidal and translabyrinthine access for the excision of cholesterol granulomas of the petrous apex. The different accesses are compared using a neuro-navigation-supported surgical technique with respect to its complications, drainage possibilities, outcomes, and recurrence of symptoms.

Citing Articles

Assessing the feasibility of the transmastoid infralabyrinthine approach without decompression of the jugular bulb to the extradural part of the petrous apex and petroclival junction prior to surgery.

Cinibulak Z, Poggenborg J, Schliwa S, Al-Afif S, Ostovar N, Krauss J Acta Neurochir (Wien). 2024; 166(1):151.

PMID: 38530445 PMC: 10965636. DOI: 10.1007/s00701-024-06044-8.

Characteristics and Clinical Management Strategy of Petrous Apex Cholesterol Granulomas.

de Bock S, Szweryn W, Jansen T, Otten J, Mulder J, Waterval J Cancers (Basel). 2023; 15(4).

PMID: 36831654 PMC: 9953853. DOI: 10.3390/cancers15041313.

Surgical management of petrous apex cholesteatomas in the pediatric population: A systematic review.

Reardon T, Turnow M, Elston S, Brown N, Koller G, Sharma S Surg Neurol Int. 2022; 13:494.

PMID: 36447849 PMC: 9699891. DOI: 10.25259/SNI_667_2022.

Surgical approaches to the petrous apex.

Li K, Agarwal V, Moskowitz H, Abuzeid W World J Otorhinolaryngol Head Neck Surg. 2020; 6(2):106-114.

PMID: 32596655 PMC: 7296478. DOI: 10.1016/j.wjorl.2019.11.002.

[The infracochlear approach for diagnostic petrous apicotomy].

Plontke S, Kosling S, Schilde S, Wittlinger J, Kisser U HNO. 2019; 67(10):791-795.

PMID: 31187150 DOI: 10.1007/s00106-019-0687-6.

References

Mosnier I, Cyna-Gorse F, Grayeli A, Fraysse B, Martin C, Robier A . Management of cholesterol granulomas of the petrous apex based on clinical and radiologic evaluation. Otol Neurotol. 2002; 23(4):522-8. DOI: 10.1097/00129492-200207000-00022. View

Lorenz K, Hamer G, Sator W, Maier H . [Cholesterol granuloma of the petrous apex--etiology, diagnosis and therapy]. Laryngorhinootologie. 1996; 75(12):775-82. DOI: 10.1055/s-2007-997675. View

Muckle R, De La Cruz A, Lo W . Petrous apex lesions. Am J Otol. 1998; 19(2):219-25. View

Weiland D, Aygun N . An unusual presentation of a cholesterol granuloma in a pneumatized pterygoid process of the sphenoid sinus. Otolaryngol Head Neck Surg. 2007; 136(1):153-4. DOI: 10.1016/j.otohns.2006.03.036. View

Arriaga M, Brackmann D . Differential diagnosis of primary petrous apex lesions. Am J Otol. 1991; 12(6):470-4. View

Kanzaki S, Araki Y, Okamoto Y, Kurita A, Ogawa K . Cholesterol granuloma surrounding the endolymphatic sac. Auris Nasus Larynx. 2006; 34(1):95-100. DOI: 10.1016/j.anl.2006.05.016. View

Graham M, Kemink J, Latack J, Kartush J . The giant cholesterol cyst of the petrous apex: a distinct clinical entity. Laryngoscope. 1985; 95(11):1401-6. DOI: 10.1288/00005537-198511000-00021. View

DiNardo L, Pippin G, Sismanis A . Image-guided endoscopic transsphenoidal drainage of select petrous apex cholesterol granulomas. Otol Neurotol. 2003; 24(6):939-41. DOI: 10.1097/00129492-200311000-00020. View

Brackmann D, Toh E . Surgical management of petrous apex cholesterol granulomas. Otol Neurotol. 2002; 23(4):529-33. DOI: 10.1097/00129492-200207000-00023. View

10.

Gacek R . Diagnosis and management of primary tumors of the petrous apex. Ann Otol Rhinol Laryngol. 1975; 84(1 PT. 2 SUPPL 18):1-20. DOI: 10.1177/0003489475084S1801. View

11.

Thorne M, Gebarski S, Telian S . Rapid expansion in a previously indolent cholesterol cyst: a need for lifelong follow-up. Otol Neurotol. 2005; 27(1):124-6. DOI: 10.1097/01.mao.0000201821.41564.97. View

12.

Bockmuhl U, Khalil H, Draf W . Clinicoradiological and surgical considerations in the treatment of cholesterol granuloma of the petrous pyramid. Skull Base. 2006; 15(4):263-7. PMC: 1380265. DOI: 10.1055/s-2005-918618. View

13.

House J, Brackmann D . Cholesterol granuloma of the cerebellopontine angle. Arch Otolaryngol. 1982; 108(8):504-6. DOI: 10.1001/archotol.1982.00790560042012. View

14.

Jackler R, Cho M . A new theory to explain the genesis of petrous apex cholesterol granuloma. Otol Neurotol. 2003; 24(1):96-106; discussion 106. DOI: 10.1097/00129492-200301000-00020. View

15.

Terao T, Onoue H, Hashimoto T, Ishibashi T, Kogure T, Abe T . Cholesterol granuloma in the petrous apex: case report and review. Acta Neurochir (Wien). 2001; 143(9):947-52. DOI: 10.1007/s007010170026. View

16.

Chang P, Fagan P, Atlas M, Roche J . Imaging destructive lesions of the petrous apex. Laryngoscope. 1998; 108(4 Pt 1):599-604. DOI: 10.1097/00005537-199804000-00025. View

17.

Thedinger B, Nadol Jr J, Montgomery W, Thedinger B, Greenberg J . Radiographic diagnosis, surgical treatment, and long-term follow-up of cholesterol granulomas of the petrous apex. Laryngoscope. 1989; 99(9):896-907. DOI: 10.1288/00005537-198909000-00003. View

18.

Lo W, Brackmann D, Gruskin P . Cholesterol granuloma of the petrous apex: CT diagnosis. Radiology. 1984; 153(3):705-11. DOI: 10.1148/radiology.153.3.6494466. View

19.

de la Cruz A, Teufert K . Transcochlear approach to cerebellopontine angle and clivus lesions: indications, results, and complications. Otol Neurotol. 2009; 30(3):373-80. DOI: 10.1097/MAO.0b013e31819a892b. View