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J Neurol Surg B Skull Base 2012; 73 - A066
DOI: 10.1055/s-0032-1312114

Endoscopic Endonasal Approach to Cholesterol Granulomas of the Petrous Apex: A Series of 17 Patients

Alessandro Paluzzi 1(presenter), Matthew Tormenti 1, Maria Koutourousiou 1, Carlos D. Pinheiro-Neto 1, Juan C. Fernandez-Miranda 1, Paul Gardner 1, Carl Snyderman 1
  • 1Pittsburgh, USA

Objective: The aim of this study was to report the results of a consecutive series of patients who underwent an endoscopic endonasal approach (EEA) for drainage of a petrous apex cholesterol granuloma.

Patients and Methods: Seventeen cases with a confirmed diagnosis of petrous apex cholesterol granuloma were identified out of a database of more than 1600 patients who underwent an EEA to skull base lesions at our institution from 1998 to 2011. Their clinical outcomes were reviewed and compared with previous series of open approaches.

Results: Nine patients underwent a transclival approach and eight patients had a combined transclival and infrapetrous approach. A Silastic stent was used in 11 patients (65%), a miniflap in 4 (24%), and a simple marsupialization of the cyst was employed in 3 patients (18%). All symptomatic patients had partial or complete improvement of their symptoms postoperatively and at follow-up (mean follow-up was 20 months; range, 3–67 months). Three patients (18%) developed complications including epistaxis, chronic serous otitis media, eye dryness and a transient 6th nerve palsy. Two patients (12%) had a symptomatic recurrence of the cyst requiring repeat endoscopic endonasal drainage. There were no instances of ICA injuries, CSF leaks, or new hearing loss. The mean postoperative hospital stay was 2 days (range, 0.7–4.6 days). These results were comparable to previous series of open approaches to petrous apex cholesterol granulomas. There was a strong correlation between the size of the cyst and type of approach chosen (Rpb = +0.67, P = 0.003359) and a very strong correlation between the degree of medial extension (defined by the v-angle) and the choice of approach (Rpb = +0.81, P < 0.0001). Based on these observations, an algorithm for guiding the choice of the most appropriate route of drainage is suggested.

Conclusions: The EEA is a safe and effective alternative to traditional open approaches to petrous apex cholesterol granulomas.