Endoscopic endonasal management of recurrent petrous apex cholesterol granuloma

McLaughlin Nancy, Daniel F. Kelly, Daniel M. Prevedello, Kiarash Shahlaie, Ricardo L. Carrau, Amin B. Kassam

Research output: Contribution to journalArticle

14 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)190-196
Number of pages7
JournalJournal of Neurological Surgery, Part B: Skull Base
Volume73
Issue number3
DOIs
StatePublished - 2012
Externally publishedYes

Fingerprint

Granuloma
Cholesterol
Cysts
Recurrence
Splints
Abducens Nerve
Sphenoid Sinus
Paresis
Stents
Drainage
Communication

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 journalArticle

Nancy, McLaughlin ; Kelly, Daniel F. ; Prevedello, Daniel M. ; Shahlaie, Kiarash ; Carrau, Ricardo L. ; Kassam, Amin B. / Endoscopic endonasal management of recurrent petrous apex cholesterol granuloma. In: Journal of Neurological Surgery, Part B: Skull Base. 2012 ; Vol. 73, No. 3. pp. 190-196.
@article{0305cf6e3f3f4af58e8c7c1696f66efa,
title = "Endoscopic endonasal management of recurrent petrous apex cholesterol granuloma",
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.",
keywords = "Cholesterol granuloma, Endoscopy, Expanded endonasal approach, Petrous apex, Transsphenoidal approach",
author = "McLaughlin Nancy and Kelly, {Daniel F.} and Prevedello, {Daniel M.} and Kiarash Shahlaie and Carrau, {Ricardo L.} and Kassam, {Amin B.}",
year = "2012",
doi = "10.1055/s-0032-1312706",
language = "English (US)",
volume = "73",
pages = "190--196",
journal = "Journal of Neurological Surgery, Part B: Skull Base",
issn = "2193-6331",
publisher = "Thieme Medical Publishers",
number = "3",

}

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 -