A Novel Case of Paediatric Petrous Apex Cholesterol Granuloma

Abstract

The petrous apex is medial most part of temporal bone, which is surrounded by vital structures. Cholesterol granuloma is the most common benign lesion of the petrous apex. Symptoms are related to mass effect and/or direct involvement of closely adjacent vital structures. The lesions can be manged either by open surgery via craniotomy or through the newer endoscopic approach. Case report and review of the literature concerning cholesterol granulomas of the petrous apex and their management. The lesion was approached endoscopically trans nasal and trans sphenoid and cholesterol granuloma was excised and marsupialised. Post operative patient recovery was uneventful. Endonasal Endoscopic approach has significantly lower complication rate when compared to open approaches. Petrous apex lesions are rare and need a multidisciplinary team approach for optimal management. By endoscopic approach one can remove lesion or marsupialize the sac with natural drainage into sinus and result in better prognosis and minimal chance of recurrence. Endonasal procedure has also lower complication rates and shorter median follow-up than open approaches.

Keywords: Cholesterol granuloma; Endoscopic endonasal approach; Petrous apex.