Cholesterol granulomas.

PURPOSE OF REVIEW: This paper reviews the literature relating to the pathogenesis, diagnosis and management of petrous apex cholesterol granulomas.

RECENT DEVELOPMENTS: Diagnosis of cholesterol granulomas can be challenging due to the rarity of this surgical condition and similarities to other petrous apex pathology. Recent literature reports novel locations of cholesterol granulomas, provides support for a new theory of pathogenesis, describes additional cases of endoscopic approaches to excision, and evaluates the efficacy of stenting to prevent recurrence of the lesion.

SUMMARY: Cholesterol granulomas of the petrous apex are significant due to their similarity to other petrous apex lesions, their adverse effect on cranial nerves and their challenging surgical location. These lesions are now believed to be an inflammatory reaction to the by-products of eroded marrow cavities in the temporal bone. The ideal surgical approach takes into account the hearing status of the patient and lesion location and may include the endoscopic transsphenoid, transmastoid, infralabyrinthine, middle fossa, and transotic approaches. Lesions should be excised, drained, and stented with the largest diameter silicone stent possible.