title: Upper Nasopharyngeal Corridor for Transnasal Endoscopic Drainage of Petroclival Cholesterol Granulomas: Alternative Access in Conchal Sphenoid Patients.
abstract: Background Cholesterol granulomas arising at the petrous apex can be treated via traditional open surgical, endoscopic, and endoscopic-assisted approaches. Endoscopic approaches require access to the sphenoid sinus, which is technically challenging in patients with conchal sphenoidal anatomy. Clinical Presentation A 55-year-old woman presented with intermittent headaches and tinnitus. Formal audiometry demonstrated moderately severe bilateral hearing loss. CT of the temporal bones and sella revealed a well-demarcated expansile lytic mass. MRI of the face, orbit, and neck showed a right petrous apex mass measuring 22 × 18 × 19 mm that was hyperintense on T1- and T2-weighted images without enhancement, consistent with a cholesterol granuloma. The patient had a conchal sphenoidal anatomy. Operative Technique Herein, we present an illustrative case of a low-lying petroclival cholesterol granuloma in a patient with conchal sphenoidal anatomy to describe an alternative high nasopharyngeal corridor for endoscopic transnasal transclival access. Postoperative Course Postoperatively, the patient's symptoms recovered and no complications occurred. Follow-up imaging demonstrated a patent drainage tract without evidence of recurrence. Conclusion In patients with a conchal sphenoid sinus, endoscopic transnasal transclival access can be gained using a high nasopharyngeal approach. This corridor facilitates safe access to these lesions and others in this location.
authors.affiliation: Emory University School of Medicine, Department of Neurosurgery, Atlanta, GA, United States.
authors.forename: Nefize
authors.initials: N
authors.lastname: Turan
authors.affiliation: Emory University School of Medicine, Department of Neurosurgery, Atlanta, GA, United States.
authors.forename: Griffin R
authors.initials: GR
authors.lastname: Baum
authors.affiliation: Emory University School of Medicine, Department of Neurosurgery, Atlanta, GA, United States.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Holland
authors.affiliation: Emory University School of Medicine, Department of Neurosurgery, Atlanta, GA, United States.
authors.forename: Faiz U
authors.initials: FU
authors.lastname: Ahmad
authors.affiliation: Emory University School of Medicine, Department of Otolaryngology, Head and Neck Surgery, Atlanta, GA, United States.
authors.forename: Oswaldo A
authors.initials: OA
authors.lastname: Henriquez
authors.affiliation: Emory University School of Medicine, Department of Neurosurgery, Atlanta, GA, United States.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Pradilla
keywords: cholesterol granuloma; endoscopic; nasopharyngeal; petroclival; petrous apex