title: Orbitofrontal Cholesterol Granuloma: Four Case Reports and a Systematic Review of the English Literature.
abstract: BACKGROUND
  Primary orbitofrontal cholesterol granuloma (OFCG) is rare. We present 4 cases of OFCG and a systematic literature review to examine patient characteristics, presentation, treatment, and outcome.
  
  
  METHODS
  Our institutional records were reviewed for OFCG cases. A systematic literature review was performed using PubMed. Inclusion criteria were English-language studies with pathology-proven OFCG. Exclusion criteria were OFCG in a craniofacial sinus. The search-string yielded 172 results. Fifty studies met inclusion criteria (39 primary and 11 secondary), and relevant data were reviewed.
  
  
  RESULTS
  Four patients underwent surgery for OFCG at our institution (ages 53, 43, 34, and 43; 3 females, 1 male). All patients were treated with surgery using a tailored frontal-orbital craniotomy with complete resection. There was no recurrence at 12-month, 4-year, 10-year, and 22-year follow-up for each patient, respectively. Systematic review of the literature identified 172 patients. Follow-up was available in 93 patients (54.1%) with a mean follow-up of 43.3 months. Seven patients demonstrated recurrence at a median of 36 months following surgery. Combining our 4 cases with the 93 patients with reported follow-up gives a recurrence rate of 7% (7/97). Recurrence was associated with incomplete resection and an orbital approach.
  
  
  CONCLUSIONS
  Thorough removal of the lesion with curettage of the boney cavity is recommended for OFCG. Recurrence following complete removal of OFCG is rare.
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Hughes
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA.
authors.forename: Jeffery T
authors.initials: JT
authors.lastname: Jacob
authors.affiliation: Department of Ophthalmology, Mayo Clinic School of Medicine, Rochester, Minnesota, USA.
authors.forename: James A
authors.initials: JA
authors.lastname: Garrity
authors.affiliation: Department of Pathology, Mayo Clinic School of Medicine, Rochester, Minnesota, USA.
authors.forename: Diva R
authors.initials: DR
authors.lastname: Salomao
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA. Electronic address: link.michael@mayo.edu.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Link
mesh_terms: D000328:Adult; D002784:Cholesterol; D005260:Female; D006099:Granuloma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D009916:Orbital Diseases / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D002784:Cholesterol
keywords: Cholesterol granuloma; Chronic hematic cyst; Orbital cholesterol granuloma; Orbitofrontal cholesterol granuloma