Cholesterol granulomas are the most common lesion of the petrous apex. Traditionally, lesions of the petrous apex have been accessible via open, infracochlear, and transtemporal approaches. We describe two cases in which the endoscopic transsphenoidal approach was used to manage this lesion. The design of this study is as a review of new endoscopic approaches. The setting of the study is a tertiary referral unit in a London teaching hospital. Case 1: A 53-year-old man diagnosed with bilateral cholesterol granulomas of the petrous apices. Case 2: A 32-year-old woman diagnosed with a rightsided cholesterol granuloma of the petrous apex. The main outcome measures were symptom resolution and postoperative complications. An endoscopic transsphenoidal approach was used in the first case. In the second case, the lesion was approached through the nasopharynx, an approach that has not been described previously. Both patients' symptoms resolved and no complications occurred. Transsphenoidal endoscopic removal of cholesterol granulomas is a recent advance in the extended applications of sinus surgery. It allows for a less invasive procedure with markedly less associated morbidity.