Otoneurological management of petrous apex cholesterol granuloma

Endoscopic transsphenoidal surgery using pedicle vascularized nasoseptal flap for cholesterol granuloma in petrous apex: A technical note

“…The surgical resection includes the middle fossa [4][5][6], translabyrinthine, or and infratemporal type B approaches [3]. The most important advantage of surgical resection is a lower recurrence rate than the drainage surgery [4,5].…”

“…The drainage surgery for PACG includes the transsphenoidal, infralabyrinthne, or and infracochlear approaches [1,3], and endoscopic TSS has been included among them recently. In general, TSS is indicated for lesions that abut the posterior wall of the sphenoid sinus [19].…”

“…Patients presenting with symptoms, such as dizziness, pressure sensation, tinnitus, hearing loss, otalgia, or headache, are treated by surgery, but the optimal surgical strategy is still controversial [2]. Direct resection using a middle fossa approach would yield relatively few recurrences, but it is quite invasive and has a risk of severe postoperative complications [3][4][5][6]. Recently, many reports on endoscopic transsphenoidal surgery (TSS) for PACG drainage have been published [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26].…”

Minimally Invasive Endoscopic Endonasal Management of Skull Base Cholesterol Granulomas

“…They are believed to occur as a result of the occlusion of pneumatized air cells of the petrous or mastoid bone, which results in negative pressure and subsequent extravasation of fluid into the mucosa of these air cells. Subsequent mucosal breakdown leads to hemorrhage, and degrading blood products (hemosiderin to cholesterol) result in a granulomatous reaction (1,9,10).…”

“…Traditionally, CGs have been managed by neuro-otologists, using a variety of transtemporal approaches (1,2,6,10). The first report on the use of transsphenoidal route was published by Montgomery in 1977 (7), and Griffith and Terrel were the first to describe the use of endoscope in addressing this pathology endonasally (5).…”