Abstract
Introduction: Petrous apex cholesterol granulomas (PACGs) are uncommon lesions. Recurrence following transcranial or endonasal approaches to aerate the cyst occurs in up to 60% of cases. We describe the technical nuances pertinent to the endonasal endoscopic management of a recurrent symptomatic PACG and review the literature. Results: A 19-year-old woman presented with a recurrent abducens nerve paresis. Four months prior, she underwent an endonasal transsphenoidal surgery (TSS) for drainage of a symptomatic PACG. Current imaging documented recurrence of the right PACG. Transsphenoidal and infrapetrous approaches were performed to obtain a wider bony opening along the petrous apex and drain the cyst. A Doyle splint was inserted into the cyst's cavity and extended out into the sphenoid sinus, maintaining patency during the healing process. Three months after surgery, the splint was removed endoscopically, allowing visualization of a patent cylindrical communication between both aerated cavities. The patient remains symptom-free and recurrence-free. Conclusion: Endoscopic endonasal surgery must be adapted to manage a recurrent PACG. A TSS may not be suf ficient. An infrapetrous approach with wider bony opening, extensive removal of the cyst's anterior wall, and the use of a stent are indicated for the treatment of recurrent PACG and to prevent recurrences.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 190-196 |
| Number of pages | 7 |
| Journal | Journal of Neurological Surgery, Part B: Skull Base |
| Volume | 73 |
| Issue number | 3 |
| DOIs | |
| State | Published - 2012 |
| Externally published | Yes |
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Keywords
- Cholesterol granuloma
- Endoscopy
- Expanded endonasal approach
- Petrous apex
- Transsphenoidal approach
ASJC Scopus subject areas
- Clinical Neurology
Cite this
Endoscopic endonasal management of recurrent petrous apex cholesterol granuloma. / Nancy, McLaughlin; Kelly, Daniel F.; Prevedello, Daniel M.; Shahlaie, Kiarash; Carrau, Ricardo L.; Kassam, Amin B.
In: Journal of Neurological Surgery, Part B: Skull Base, Vol. 73, No. 3, 2012, p. 190-196.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Endoscopic endonasal management of recurrent petrous apex cholesterol granuloma
AU - Nancy, McLaughlin
AU - Kelly, Daniel F.
AU - Prevedello, Daniel M.
AU - Shahlaie, Kiarash
AU - Carrau, Ricardo L.
AU - Kassam, Amin B.
PY - 2012
Y1 - 2012
N2 - Introduction: Petrous apex cholesterol granulomas (PACGs) are uncommon lesions. Recurrence following transcranial or endonasal approaches to aerate the cyst occurs in up to 60% of cases. We describe the technical nuances pertinent to the endonasal endoscopic management of a recurrent symptomatic PACG and review the literature. Results: A 19-year-old woman presented with a recurrent abducens nerve paresis. Four months prior, she underwent an endonasal transsphenoidal surgery (TSS) for drainage of a symptomatic PACG. Current imaging documented recurrence of the right PACG. Transsphenoidal and infrapetrous approaches were performed to obtain a wider bony opening along the petrous apex and drain the cyst. A Doyle splint was inserted into the cyst's cavity and extended out into the sphenoid sinus, maintaining patency during the healing process. Three months after surgery, the splint was removed endoscopically, allowing visualization of a patent cylindrical communication between both aerated cavities. The patient remains symptom-free and recurrence-free. Conclusion: Endoscopic endonasal surgery must be adapted to manage a recurrent PACG. A TSS may not be suf ficient. An infrapetrous approach with wider bony opening, extensive removal of the cyst's anterior wall, and the use of a stent are indicated for the treatment of recurrent PACG and to prevent recurrences.
AB - Introduction: Petrous apex cholesterol granulomas (PACGs) are uncommon lesions. Recurrence following transcranial or endonasal approaches to aerate the cyst occurs in up to 60% of cases. We describe the technical nuances pertinent to the endonasal endoscopic management of a recurrent symptomatic PACG and review the literature. Results: A 19-year-old woman presented with a recurrent abducens nerve paresis. Four months prior, she underwent an endonasal transsphenoidal surgery (TSS) for drainage of a symptomatic PACG. Current imaging documented recurrence of the right PACG. Transsphenoidal and infrapetrous approaches were performed to obtain a wider bony opening along the petrous apex and drain the cyst. A Doyle splint was inserted into the cyst's cavity and extended out into the sphenoid sinus, maintaining patency during the healing process. Three months after surgery, the splint was removed endoscopically, allowing visualization of a patent cylindrical communication between both aerated cavities. The patient remains symptom-free and recurrence-free. Conclusion: Endoscopic endonasal surgery must be adapted to manage a recurrent PACG. A TSS may not be suf ficient. An infrapetrous approach with wider bony opening, extensive removal of the cyst's anterior wall, and the use of a stent are indicated for the treatment of recurrent PACG and to prevent recurrences.
KW - Cholesterol granuloma
KW - Endoscopy
KW - Expanded endonasal approach
KW - Petrous apex
KW - Transsphenoidal approach
UR - http://www.scopus.com/inward/record.url?scp=84901699763&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84901699763&partnerID=8YFLogxK
U2 - 10.1055/s-0032-1312706
DO - 10.1055/s-0032-1312706
M3 - Article
AN - SCOPUS:84901699763
VL - 73
SP - 190
EP - 196
JO - Journal of Neurological Surgery, Part B: Skull Base
JF - Journal of Neurological Surgery, Part B: Skull Base
SN - 2193-6331
IS - 3
ER -