J Neurol Surg Rep 2016; 77(01): e017-e022
DOI: 10.1055/s-0035-1567865
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Upper Nasopharyngeal Corridor for Transnasal Endoscopic Drainage of Petroclival Cholesterol Granulomas: Alternative Access in Conchal Sphenoid Patients

Nefize Turan
1  Emory University School of Medicine, Department of Neurosurgery, Atlanta, GA, United States
,
Griffin R. Baum
1  Emory University School of Medicine, Department of Neurosurgery, Atlanta, GA, United States
,
Christopher M. Holland
1  Emory University School of Medicine, Department of Neurosurgery, Atlanta, GA, United States
,
Faiz U. Ahmad
1  Emory University School of Medicine, Department of Neurosurgery, Atlanta, GA, United States
,
Oswaldo A. Henriquez
2  Emory University School of Medicine, Department of Otolaryngology, Head and Neck Surgery, Atlanta, GA, United States
,
Gustavo Pradilla
1  Emory University School of Medicine, Department of Neurosurgery, Atlanta, GA, United States
› Author Affiliations
Further Information

Publication History

05 October 2015

14 September 2015

Publication Date:
16 November 2015 (online)

Abstract

Background Cholesterol granulomas arising at the petrous apex can be treated via traditional open surgical, endoscopic, and endoscopic-assisted approaches. Endoscopic approaches require access to the sphenoid sinus, which is technically challenging in patients with conchal sphenoidal anatomy.

Clinical Presentation A 55-year-old woman presented with intermittent headaches and tinnitus. Formal audiometry demonstrated moderately severe bilateral hearing loss. CT of the temporal bones and sella revealed a well-demarcated expansile lytic mass. MRI of the face, orbit, and neck showed a right petrous apex mass measuring 22 × 18 × 19 mm that was hyperintense on T1- and T2-weighted images without enhancement, consistent with a cholesterol granuloma. The patient had a conchal sphenoidal anatomy.

Operative Technique Herein, we present an illustrative case of a low-lying petroclival cholesterol granuloma in a patient with conchal sphenoidal anatomy to describe an alternative high nasopharyngeal corridor for endoscopic transnasal transclival access.

Postoperative Course Postoperatively, the patient's symptoms recovered and no complications occurred. Follow-up imaging demonstrated a patent drainage tract without evidence of recurrence.

Conclusion In patients with a conchal sphenoid sinus, endoscopic transnasal transclival access can be gained using a high nasopharyngeal approach. This corridor facilitates safe access to these lesions and others in this location.

Content of this work was presented in poster presentation form at the 25th Annual North American Skull Base Society Meeting Tampa, Florida, USA, February 20–22, 2015.