Cholesterol Granuloma in the Petrous Apex: Case Report and Review |
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Authors: | T Terao H Onoue T Hashimoto T Ishibashi T Kogure T Abe |
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Institution: | (1) Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Tokyo, Japan, JP;(2) Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan, JP |
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Abstract: | Summery.
Cholesterol granuloma in the petrous apex presents with various symptoms of cranial nerve dysfunction, so the selection for
surgical treatment remains controversial. We report a 41-year-old woman with a cholesterol granuloma at the left petrous apex,
which was totally resected via a combined middle fossa and posterior transpetrosal approach. In a review of 92 cases, including
our case, treated for petrous apex cholesterol granuloma between 1990 and 2001, 38 were men (41.3%) and 54 were women (58.7%).
The mean age of these patients was 37.4 years (males were 35.2 years, females were 39.4 years). The most common presenting
clinical symptom was hearing loss due to dysfunction of cranial nerve VIII. Seventy-nine patients, including our case, underwent
operation, and 13 patients were managed without surgery. The most frequently selected surgical approach was middle cranial
fossa approach. Revision surgery (including the 2 cases who underwent revision twice and three times) was performed in 12
patients (15.2%). In 92 cases, all of those who underwent total removal have not shown re-accumulation of cyst contents. On
the other hand, 11.4% of the patients with or without permanent drainage route proceeded by subtotal removal of the cyst wall
needed revision surgery because of stenosis of the drainage route. Therefore we conclude that the most important treatment
for the prevention of re-accumulation of cyst contents may be the extent of the cyst wall resection rather than the establishment
of permanent drainage route. |
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Keywords: | : Cholesterol granuloma petrous apex drainage total resection |
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