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Transsphenoidal and infralabyrinthine approach of the petrous apex cholesterol granuloma

  • Otology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Space-demanding or destructive changes in the petrous bone are often challenging differential diagnosis. Cholesterol granulomas of the petrous apex can clinically present in a combination of hearing loss, vertigo, tinnitus, chronic cephalgia, impairment of facial nerve function, neuralgic pain of the nervus trigeminus, or manifest diplopia by the nerve palsy of the nervus abducens. CT-morphologically cholesterol granulomas appear as soft-tissue density masses, which may display a discrete rim after intravenous administration of a contrast agent. The MRI, T1 as well as T2-weighted images show a strong signal in the area of the lesion. Depending on the individual anatomical conditions, the surgical access must be carefully chosen between transsphenoidal, transtemporal, infracochlear/-labyrinthine, or translabyrinthine. Here, we present the transsphenoidal and translabyrinthine access for the excision of cholesterol granulomas of the petrous apex. The different accesses are compared using a neuro-navigation-supported surgical technique with respect to its complications, drainage possibilities, outcomes, and recurrence of symptoms.

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Authors and Affiliations

  1. Department of Otolaryngology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany

    Karl-Ludwig Bruchhage, Barbara Wollenberg & Anke Leichtle

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  1. Karl-Ludwig Bruchhage
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  2. Barbara Wollenberg
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  3. Anke Leichtle
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Correspondence to Karl-Ludwig Bruchhage.

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Bruchhage, KL., Wollenberg, B. & Leichtle, A. Transsphenoidal and infralabyrinthine approach of the petrous apex cholesterol granuloma. Eur Arch Otorhinolaryngol 274, 2749–2756 (2017). https://doi.org/10.1007/s00405-017-4593-9

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  • DOI: https://doi.org/10.1007/s00405-017-4593-9

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