title: CT venography: use in selecting a surgical approach for the treatment of petrous apex cholesterol granulomas.
abstract: OBJECTIVE
  To demonstrate the use of computed tomographic (CT) venography in selecting a surgical approach for cholesterol granulomas.
  
  
  METHODS
  Retrospective case review.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Three patients presented with symptomatic petrous apex cholesterol granulomas with extensive bone erosion involving the jugular fossa.
  
  
  METHODS
  Computed tomographic venography was performed on each patient before selecting a surgical approach for drainage.
  
  
  METHODS
  Localization of the jugular bulb in relation to the petrous carotid artery and basal turn of the cochlea was ascertained in each subject.
  
  
  RESULTS
  Three patients with large symptomatic cholesterol granulomas were identified. Conventional CT demonstrated extensive bone erosion involving the jugular fossa in each patient. The location of the jugular bulb and its proximity to the petrous carotid artery and basal turn of the cochlea could not be determined with conventional temporal bone CT and magnetic resonance imaging. Computed tomographic venography provided the exact location of the jugular bulb in all 3 patients. The favorable position of the jugular bulb in all 3 cases permitted drainage of these lesions using an infracochlear approach.
  
  
  CONCLUSIONS
  Computed tomographic venography provided invaluable information in 3 patients with large symptomatic cholesterol granulomas. All 3 patients were previously thought to be unsuitable candidates for an infracochlear or infralabyrinthine approach because of the unknown location of the jugular bulb.
authors.affiliation: Departments of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, 75390-9035, USA. brandon.isaacson@utsouthwestern.edu
authors.forename: Brandon
authors.initials: B
authors.lastname: Isaacson
authors.forename: Joe Walter
authors.initials: JW
authors.lastname: Kutz
authors.forename: Dianne
authors.initials: D
authors.lastname: Mendelsohn
authors.forename: Peter S
authors.initials: PS
authors.lastname: Roland