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J Neurol Surg B Skull Base 2013; 74(06): 342-346
DOI: 10.1055/s-0033-1345107
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Image-Guided Percutaneous Aspiration and Gelfoam Treatment of Petrous Apex Cholesterol Granuloma: A New Theory and Method for Diagnosis and Treatment

Thomas C. Lee
1   Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Deepak Raghavan
1   Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Hugh D. Curtin
1   Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
2   Department of Radiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, United States
› Author Affiliations
Further Information

Publication History

23 January 2013

11 February 2013

Publication Date:
26 April 2013 (online)

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Abstract

Although diagnosis of cholesterol granulomas of the skull base can be straightforward with computed tomography (CT) and magnetic resonance imaging (MRI) appearance, treatment is controversial with various skull base approaches described in the literature. This report describes a 35-year-old man who presented with a symptomatic, enlarging cystic lesion in the left petrous apex and clivus that had imaging features of a cholesterol granuloma (cholesterol cyst). Due to a prior history of treated mediastinal germ cell tumor, pathologic confirmation of the lesion was requested. A CT-guided percutaneous aspiration revealed dark used motor oil–like fluid. Continued aspiration yielded a change in the character of the fluid to marrow red. Injection of contrast revealed no communication with cerebrospinal fluid. Gelfoam (Pfizer, New York, New York, USA) was subsequently injected percutaneously into the residual cavity. Histopathology showed no evidence of malignancy and follow-up MRI at 1 month, 3 months, 6 months, and 1 year demonstrated continued decrease in size and signal of the lesion.

Keywords

cholesterol granuloma - petrous apex - Gelfoam - image guided
 

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