Int. Adv. Otol. 2009; 5(3); 404-407

Lobulated petrous apex cholesterol granuloma treated with combined infracochlear and transsphenoidal approach
Harukazu Hiraumi, Takayuki Nakagawa, Shin-ichi Kanemaru, Juichi Ito

Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan, hhiraumi@ent.kuhp.kyoto-u.ac.jp

Petrous apex cholesterol granulomas are relatively rare lesions. They are usually unilocular and treated with simple fenestration.
However, lobulated lesions require total removal of debris inside the cysts. Herein, we report a first case with a lobulated
petrous apex cholesterol granuloma. The lesion extended from cerebello-pontine angel to the clivus. It was lobulated and contained
debris, meaning that total surgical access was necessary to avoid intra-lesional obstruction. Consecutive infracochlear
and transsphenoidal approach under image guidance enabled total removal of debris and successful drainage without causing
further neurological deficits.