Košec A.a,b· Prnjak J.b· Tomljenović R.a· Ries M.a,b

Author affiliations

aDepartment of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
bSchool of Medicine, University of Zagreb, Zagreb, Croatia

Log in to MyKarger to check if you already have access to this content.

Buy FullText & PDF Unlimited re-access via MyKarger Unrestricted printing, no saving restrictions for personal use read more

CHF 38.00 *
EUR 35.00 *
USD 39.00 *

Select

KAB

Buy a Karger Article Bundle (KAB) and profit from a discount!

If you would like to redeem your KAB credit, please log in.

Save over 20% compared to the individual article price.

Learn more

Rent via DeepDyve Unlimited fulltext viewing of this article Organize, annotate and mark up articles Printing and downloading restrictions apply

Start free trial

Subscribe Access to all articles of the subscribed year(s) guaranteed for 5 years Unlimited re-access via Subscriber Login or MyKarger Unrestricted printing, no saving restrictions for personal use read more

Subcription rates

Select

* The final prices may differ from the prices shown due to specifics of VAT rules.

Article / Publication Details

Received: May 29, 2022
Accepted: February 28, 2023
Published online: April 05, 2023

Number of Print Pages: 4
Number of Figures: 4
Number of Tables: 0

ISSN: 0301-1569 (Print)
eISSN: 1423-0275 (Online)

For additional information: https://www.karger.com/ORL

Abstract

Cholesterol granuloma of the petrous bone is a foreign body giant cell reaction to cholesterol deposits with symptoms including hearing loss, vestibular dysfunction, and cranial nerve deficit as a result of cystic mass compression. Surgical treatment is often difficult to plan due to limited access to the lesion and possible injury to surrounding structures. We report on a case of petrous apex cholesterol granuloma drainage through an infracochlear approach. A 27-year-old female patient presented with acute diplopia due to left-sided abducens paralysis. Multislice computed tomography (MSCT) and magnetic resonance (MR) imaging described a 3.5-cm well-marginated lesion in petrous bone apex, compressing the left abducens nerve at the point of entry into the cavernous sinus, corresponding to cholesterol granuloma. The patients was surgically treated through a transcanal infracochlear approach, since preserving the external and middle ear conduction mechanisms was paramount for the patient. The patient was discharged on the second postoperative day and diplopia resolved within 5 days postoperatively. Six months after the surgery, her hearing on the left side is normal, and she remains symptom-free. This case underpins the value of preoperative planning when approaching the petrous apex, an anatomically complex area due to abundance of important neurovascular structures crowded in a narrow and confined region.

© 2023 S. Karger AG, Basel

References Dinh CT, Goncalves S, Bhatia R, Truong K, Telischi F, Angeli S, et al. Atypical radiographic features of skull base cholesterol granuloma. Eur Arch Otorhinolaryngol. 2016;273(6):1425–31. Brackmann DE, Toh EH. Surgical management of petrous apex cholesterol granulomas. Otol Neurotol. 2002;23(4):529–33. Jackler RK, Cho M. A new theory to explain the genesis of petrous apex cholesterol granuloma. Otol Neurotol. 2003;24(1):96–106; discussion 106. Hoa M, House JW, Linthicum FHJr. Petrous apex cholesterol granuloma: maintenance of drainage pathway, the histopathology of surgical management and histopathologic evidence for the exposed marrow theory. Otol Neurotol. 2012;(6):1059–65. Giddings NA, Brackmann DE, Kwartler JA. Transcanal infracochlear approach to the petrous apex. Otolaryngol Head Neck Surg. 1991;104(1):29–36. Cömert E, Cömert A. Surgical anatomy of the transcanal infracochlear approach. Eur Arch Otorhinolaryngol. 2022;279(1):159–68. Patron V, Humbert M, Micault E, Emery E, Hitier M. How to perform microscopic/endoscopic resection of large petrous apex lesions. Eur Ann Otorhinolaryngol Head Neck Dis. 2018 Dec;135(6):443–7. Grinblat G, Vashishth A, Galetti F, Caruso A, Sanna M. Petrous apex cholesterol granulomas: outcomes, complications, and hearing results from surgical and wait-and-scan management. Otol Neurotol. 2017;38(10):e476–85. Scopel TF, Fernandez-Miranda JC, Pinheiro-Neto CD, Peris-Celda M, Paluzzi A, Gardner PA, et al. Petrous apex cholesterol granulomas: endonasal versus infracochlear approach. Laryngoscope. 2012;122(4):751–61. Wick CC, Hansen AR, Kutz JW, Isaacson B. Endoscopic infracochlear approach for drainage of petrous apex cholesterol granulomas: a case series. Otol Neurotol. 2017;38(6):876–81. Article / Publication Details

Received: May 29, 2022
Accepted: February 28, 2023
Published online: April 05, 2023

Number of Print Pages: 4
Number of Figures: 4
Number of Tables: 0

ISSN: 0301-1569 (Print)
eISSN: 1423-0275 (Online)

For additional information: https://www.karger.com/ORL

Copyright / Drug Dosage / Disclaimer Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.