Infracochlear Drainage of Cholesterol Granulomas with Double-Barrel Stents

Objective: To describe our institutional experience with cholesterol granuloma drainage with placement of either a single-barrel or double-barrel stent.

Study Design: Retrospective chart review of surgeries performed by two surgeons. We reviewed demographics, presenting symptoms, approaches used, number of angiocatheters placed for drainage, follow-up length, and recurrence rate, as well as complications.

Setting: Tertiary referral center.

Patients: Ten patients with the diagnosis of petrous apex cholesterol granulomas treated between 1999 and 2009 with average follow-up of 15 months. Exclusion criteria included coexisting cholesteatoma, for which concurrent mastoidectomy with petrosectomy was performed.

Interventions: Infracochlear and infralabyrinthine approach either via transcanal or transmastoid exposure. When possible, an angiocatheter was placed as a drainage stent in either a single- or double-stent fashion. In cases where anatomy did not allow placement of a stent, none was placed.

Main Outcome Measures: Recurrence was defined as return of symptoms accompanied by imaging findings.

Results: Nonspecific headache was the most common presenting symptom. Others included retro-orbital pain, facial pain, dizziness, and aural fullness. There were two patients with a single stent, three patients with double barrel stent, and five with no stent. Only 1 of the 10 patients had a recurrence of symptoms, none of which occurred in the double-barrel stenting group.

Conclusion: The use of double-barrel stents yielded no recurrence. Further prospective study with a larger patient sample is needed to evaluate effectiveness of double-barrel stenting and will be conducted at our institution.