Cholesterol granuloma in the petrous apex presents with various symptoms of
cranial nerve dysfunction, so the selection for surgical treatment remains
controversial. We report a 41-year-old woman with a cholesterol granuloma
at the left petrous apex, which was totally resected via a combined middle
fossa and posterior trans-petrosal approach. In a review of 92 cases, inclu
ding our case, treated for petrous apex cholesterol granuloma between 1990
and 2001, 38 were men (41.3%) and 54 were women (58.7%). The mean age of th
ese patients was 37.4 years (males were 35.2 years, females were 39.4 years
). The most common presenting clinical symptom was hearing loss due to dysf
unction of cranial nerve VIII. Seventy-nine patients, including our case, u
nderwent operation, and 13 patients were managed without surgery. The most
frequently selected surgical approach was middle cranial fossa approach. Re
vision surgery (including the 2 cases who underwent revision twice and thre
e times) was performed in 12 patients (15.2%). In 92 cases, all of these wh
o underwent total removal have not shown re-accumulation of cyst contents.
On the other hand, 11.4% of the patients with or without permanent drainage
route proceeded by subtotal removal of the cyst wall needed revision surge
ry because of stenosis of the drainage route. Therefore we conclude that th
e most important treatment for the prevention of re-accumulation of cyst co
ntents may be the extent of the cyst wall resection rather than the establi
shment of permanent drainage route.