CHOLESTEROL GRANULOMAS OF THE PETROUS APEX - COMBINED NEUROSURGICAL AND OTOLOGICAL MANAGEMENT

Cholesterol granulomas of the head are relatively rare. Isolated lesio ns of the cerebellopontine angle are even more uncommon. In this repor t, 17 cases of petrous apex cholesterol granulomas are presented and m anagement is discussed. Symptoms at presentation included dizziness (1 4 patients), pressure (nine patients), tinnitus (eight patients), hear ing loss (eight patients), otalgia (six patients), headache (six patie nts), nausea (three patients), drainage from ear (two patients), facia l pain (two patients), seizure (two patients), lightheadedness (one pa tient), hemifacial spasm (one patient), and facial numbness (one patie nt). Six cases were managed without surgery and 11 patients underwent operative procedures. The approaches used included the infralabyrinthi ne (eight patients), transcanal-infracochlear (two patients), and tran slabyrinthine (one patient). The mean follow-up period for all cases w as 29.5 months. Of those patients managed without surgery, symptoms im proved in all except one, whose tinnitus was slightly worse. Of surgic ally treated patients, symptoms improved or remained the same except i n one with worsened dizziness. There were nine patients with hearing p resent presurgery and seven whose hearing was preserved postsurgery. T he authors pre sent a case that was managed at another center where an attempt at surgical resection through a subtemporal middle fossa appr oach was unsuccessful. This lesion was successfully treated using an i nfralabyrinthine approach with drainage into the mastoid cavity. Chole sterol granulomas of the petrous apex can be managed without surgery w hen symptoms are stable or improve. Otherwise, a transmastoid extradur al approach with simple drainage into the mastoid sinus or middle ear produces symptomatic improvement with low morbidity. Resection of petr ous apex cholesterol granulomas is not necessary.