Endoscopic Endonasal Technique for Cholesterol Granulomas of the Petrous Apex Using the Pedicled Nasoseptal Flap

Objective: To report the long-term results of the endoscopic endonasal approach for drainage of cholesterol granulomas of the petrous apex while using the nasoseptal flap to maintain patent the cavity. Study Design: A retrospective case series review. Patients/material and Methods: A retrospective analysis was performed on patients with cholesterol granuloma of the petrous apex, endoscopically managed using the nasoseptal flap, at two university centers following a uniform policy. Results: Overall 10 patients were treated between June, 2008 and December, 2013. Six were males and four females. Three patients had been previously treated through an external lateral approach. The lesions were equally distributed between the left and the right side (1:1). All patients underwent an exclusive endoscopic endonasal approach using the nasoseptal flap. In eight cases the flap was ipsilateral to the lesion while in two cases it was contralateral. No intraoperative complications were observed. The mean follow-up period was 26 months. One patient presented an asymptomatic recurrence of the cyst, which has been strictly followed up with MRI. Conclusions: In correctly selected patients, the endoscopic endonasal approach, represents a safe surgical procedure, minimally invasive and with excellent surgical outcomes. The use of the pedicled nasoseptal flap avoids the concentric growth of the granulomatous cyst epithelium, assuring ventilation and drainage of the cystic cavity.