Use of the pedicled nasoseptal flap in the endoscopic management of cholesterol granulomas of the petrous apex

Abstract

The pedicled NSF seems to be helpful in avoiding the concentric growth of the granulomatous cyst epithelium while assuring ventilation and drainage of the cyst. However, bigger studies with longer-term follow-up are needed to confirm these findings. Correct and meticulous placement of the flap inside the cystic cavity is the most critical issue for the success of the procedure.

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

“…Case reports or series of PACG treated by endoscopic TSS is summarized in The technique involving nasoseptal flap is unique technique and has been used in extended TSS to prevent postoperative cerebrospinal fluid leakage [28]. Similar to our case, endoscopic TSS using pedicle flap for PACG has been reported to achieve good outcomes [10,11,14,22]. Although the obstruction of the drainage route is a major cause of recurrence [27], post-operative CT in our case revealed a regenerated mucosa covering the inner side of CG, probably because PVNF was able to prevent the obstruction.…”

“…Before the advent of endoscopic surgery, the recurrence rate following microscopic TSS for PACG was quite high [27]. In recent years, however, the recurrence rate of endoscopic TSS has extremely reduced [10,12,16,22]. Compared with microscopy, endoscopy can achieve a wide operative field, enabling a maximum puncture of CG.…”

“…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]. Although it is a less invasive approach, the frequency of recurrence is high compared with direct resection.…”

Endoscopic Endonasal Resection of Cholesterol Granuloma of the Petrous Apex

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Submit Manuscript | http://medcraveonline.com asosseptal flap has been used to permitlong-termpatency of drainage site [4].

Material and MethodsA 43years old man presented with 6 month history of intermittent right hemicranial headache and ipsilateral conductive hearingloss. The patient had no historyof head trauma.

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“…Submit Manuscript | http://medcraveonline.com asosseptal flap has been used to permitlong-termpatency of drainage site [4].…”