title: Cholesterol granulomas of the petrous apex; endonasal endoscopic approach.
abstract: OBJECTIVE
  Cholesterol granulomas are benign lesions that sometimes occur on the petrous apex (PA). We report our experience using an endoscopic endonasal approach to remove PA cholesterol granulomas.
  
  
  METHODS
  A retrospective patient chart analysis was conducted at a tertiary care university hospital.
  
  
  RESULTS
  Four patients (3 females, 1 male) were included in this study. Patients' ages ranged from 27 to 78 years. Computed tomography (CT) and magnetic resonance imaging (MRI) for diagnosis and computer-assisted navigation were performed. The most common symptom was abducens nerve palsy. The largest granuloma measured 5 x 2 cm and was located on the left side. An endoscopic endonasal approach was chosen and navigation was applied (3/4 patients) to identify the optimal area for opening the granuloma. No complications occurred, and patients were free from recurrence during the follow-up period.
  
  
  CONCLUSIONS
  The endoscopic endonasal approach to PA cholesterol granulomas is feasible and safe. Intra-operative navigation is recommended to identify the position of the internal carotid artery and determine the safest area for opening the granuloma without damaging the artery. Another advantage of this approach is an easier follow-up through diagnostic nasal endoscopy.
authors.affiliation: ENT - University Hospital Graz, Medical University Graz, Austria. peter.tomazic@medunigraz.at
authors.forename: P V
authors.initials: PV
authors.lastname: Tomazic
authors.affiliation: ENT - University Hospital Graz, Medical University Graz, Austria.
authors.forename: U
authors.initials: U
authors.lastname: Nemetz
authors.affiliation: ENT - University Hospital Graz, Medical University Graz, Austria.
authors.forename: W
authors.initials: W
authors.lastname: Koele
authors.affiliation: ENT - University Hospital Graz, Medical University Graz, Austria.
authors.forename: C
authors.initials: C
authors.lastname: Walch
authors.affiliation: ENT - University Hospital Graz, Medical University Graz, Austria.
authors.forename: E M
authors.initials: EM
authors.lastname: Braun
authors.affiliation: ENT - University Hospital Graz, Medical University Graz, Austria.
authors.forename: G P
authors.initials: GP
authors.lastname: Hammer
authors.affiliation: Department of Neurosurgery, Medical University Graz, Graz, Austria.
authors.forename: V
authors.initials: V
authors.lastname: Gellner
authors.affiliation: Department of Neurosurgery, Medical University Graz, Graz, Austria.
authors.forename: G
authors.initials: G
authors.lastname: Clarici
authors.affiliation: ENT - University Hospital Graz, Medical University Graz, Austria.
authors.forename: H
authors.initials: H
authors.lastname: Braun
authors.affiliation: Department of Neurosurgery, Medical University Graz, Graz, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Mokry
authors.affiliation: ENT - University Hospital Graz, Medical University Graz, Austria.
authors.forename: H
authors.initials: H
authors.lastname: Stammberger
mesh_terms: D000328:Adult; D000368:Aged; D001847:Bone Diseases / Q000175:diagnosis / Q000601:surgery*; D002784:Cholesterol; D003937:Diagnosis, Differential; D004322:Drainage / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D015745:Granuloma, Foreign-Body / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D010579:Petrous Bone / Q000601:surgery*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D002784:Cholesterol