Management of cholesterol granulomas of the petrous apex based on clinical and radiologic evaluation.
OBJECTIVE
The purpose of this study was to analyze the imaging characteristics of 12 cholesterol granulomas as a function of their clinical symptoms. The results of the different surgical approaches and the management of these lesions are discussed.


METHODS
Retrospective case review.


METHODS
Five tertiary referral centers.


METHODS
Twelve patients managed for a cholesterol granuloma of the petrous apex.


METHODS
All patients were evaluated via computed tomography and magnetic resonance imaging. Eight patients required surgical drainage: through a conservative approach in seven patients (infralabyrinthine, n = 5; infracochlear, n = 2) and a transotic approach in one patient. Clinical and radiologic follow-up without surgery was the mode of treatment for four patients. The mean follow-up period was 18 months for patients who underwent operations and ranged from 6 months to 10 years for patients without operations.


RESULTS
Four patterns of clinical symptoms were noted: retrocochlear signs by an involvement of the internal auditory meatus (n = 8), headaches by a traction of the dura (n = 4), serous otitis media by a compression of the eustachian tube (n = 2), and asymptomatic lesions with no involvement of the adjacent structures (n = 2). Hearing and facial functions were preserved in all the cases treated by a noninvasive procedure. No recurrence or complication was reported in the patients who underwent operations. None of the noninvasively treated patients with cholesterol granulomas showed significant enlargement on follow-up imaging.


CONCLUSIONS
Clinical manifestations of cholesterol granulomas depend on their anatomic location and the involvement of the adjacent structures. Aggressive lesions in patients with residual hearing can be drained via an infralabyrinthine or an infracochlear approach with minimal morbidity. Follow-up must be preferred for patients with nonaggressive lesions. Although magnetic resonance imaging provides a specific diagnosis tool for cholesterol granulomas, computed tomography is essential for an accurate evaluation of the location of the cyst and choice of the surgical procedure.
Mosnier
Isabelle
I
Department of Otolaryngology, Hôpital Beaujon, Faculté Xavier Bichat, Université Paris, AP-HP 100 Boulevard du Général Leclerc, F-92118 Clichy cedex, France. imosnier@club-internet.fr
Cyna-Gorse
Françoise
F
Grayeli
Alexis Borzog
AB
Fraysse
Bernard
B
Martin
Christian
C
Robier
Alain
A
Gardini
Bertrand
B
Chelikh
Larbi
L
Sterkers
Olivier
O
D000293:Adolescent; D000328:Adult; D001847:Bone Diseases / Q000175:diagnosis / Q000378:metabolism* / Q000503:physiopathology / Q000601:surgery*; D002784:Cholesterol / Q000378:metabolism*; D003051:Cochlea / Q000503:physiopathology; D005152:Facial Muscles / Q000503:physiopathology; D005260:Female; D006099:Granuloma / Q000175:diagnosis / Q000378:metabolism* / Q000503:physiopathology / Q000601:surgery*; D006261:Headache / Q000209:etiology; D006309:Hearing; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010579:Petrous Bone; D011184:Postoperative Period; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D002784:Cholesterol