title: Use of the pedicled nasoseptal flap in the endoscopic management of cholesterol granulomas of the petrous apex.
abstract: BACKGROUND
  Nowadays the endoscopic approach represents a useful alternative to traditional surgical approaches in the treatment of cholesterol granulomas (CGs) of the petrous apex (PA). Recently the nasoseptal flap (NSF) has been employed to permit long-term patency of drainage site. The purpose of this study is to report our experience with the NSF in the endoscopic management of CG and to analyze the advantages, limitations, and outcomes of the technique.
  
  
  METHODS
  A retrospective analysis was carried out on 10 patients affected by CG of the PA who had been treated endoscopically, using the NSF.
  
  
  RESULTS
  An endoscopic transpterygoid approach was used for 6 patients and the remaining 4 were treated using the transclival approach. A NSF was used in all 10 cases. In 6 cases the flap was ipsilateral to the lesion whereas in 4 it was contralateral. In 90% of our patients no evidence of disease was observed after a mean follow-up period of 35.7 months, with resolution of their symptoms. One patient presented a recurrence because of a technical error (inadequate placement of the flap in the cavity), and has been retreated endoscopically.
  
  
  CONCLUSIONS
  The pedicled NSF seems to be helpful in avoiding the concentric growth of the granulomatous cyst epithelium while assuring ventilation and drainage of the cyst. However, bigger studies with longer-term follow-up are needed to confirm these findings. Correct and meticulous placement of the flap inside the cystic cavity is the most critical issue for the success of the procedure.
authors.affiliation: Division of Otorhinolaryngology, Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Sassari, Italy.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Karligkiotis
authors.affiliation: Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Bignami
authors.affiliation: Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Terranova
authors.affiliation: Ear, Nose, and Throat (ENT) Section, Department of Sensory Organs, Sapienza University of Rome, Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Ciniglio-Appiani
authors.affiliation: Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.
authors.forename: Abdulrahman
authors.initials: A
authors.lastname: Shawkat
authors.affiliation: Department of Otorhinolaryngology, Lariboisière Hospital, Assistance Publique-Hopitaux de Paris, Université Paris Diderot, Sorbonne Paris Cité, Equipe d'accueil (EA) Recherche Clinique Cordonnée Ville-Hôpital, Méthodologies et Société (REMES), Paris, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Verrilaud
authors.affiliation: Division of Otorhinolaryngology, Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Sassari, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Meloni
authors.affiliation: Department of Otorhinolaryngology, Lariboisière Hospital, Assistance Publique-Hopitaux de Paris, Université Paris Diderot, Sorbonne Paris Cité, Equipe d'accueil (EA) Recherche Clinique Cordonnée Ville-Hôpital, Méthodologies et Société (REMES), Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Herman
authors.affiliation: Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Castelnuovo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002784:Cholesterol; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006099:Granuloma / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D010579:Petrous Bone / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013524:Surgical Flaps
chemical_list: D002784:Cholesterol
keywords: cholesterol granuloma; endoscopic endonasal approach; nasoseptal flap; petrous apex; transclival approach; transpterygoid approach