{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:49:04Z","timestamp":1786124944189,"version":"build-2736575974"},"reference-count":6,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2021,6,10]],"date-time":"2021-06-10T00:00:00Z","timestamp":1623283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Operative Surg.","ONSURG"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Petrous apex cholesterol granulomas are believed to result from blockage of the normal aeration of the petrous air cells, resulting in a repetitive cycle of mucosal engorgement, hemorrhage, and granuloma formation.\n                    <jats:sup>1<\/jats:sup>\n                    The lesion usually progressively expands causing compressive symptoms. The thick granulomatous wall envelopes various ages of breakdown products, including a cholesterol-containing fluid, which is typically hyperintense on T1 and T2 weighted magnetic resonance imaging. Drainage procedures, regardless of the route (endoscopic, endonasal, or transtemporal), with or without stenting or marsupialization, will only temporarily drain this cholesterol-containing fluid, with consequently frequent recurrences.\n                    <jats:sup>2-5<\/jats:sup>\n                    A total exoneration of the granuloma and obliteration of the cavity with vascularized tissue will assure a more durable outcome.\n                    <jats:sup>1<\/jats:sup>\n                    The extradural zygomatic\/middle fossa approach provides a short distance to the petrous apex and is purely extradural. By sectioning the zygoma, temporal lobe retraction is avoided.\n                    <jats:sup>6<\/jats:sup>\n                    We present a case of a 29-yr-old male who presented in the year 2000 with progression of a left petrous apex cholesterol granuloma despite 2 previous drainage and stenting procedures.\n                  <\/jats:p>\n                  <jats:p>\u2003The patient consented for surgery and photo publication.<\/jats:p>\n                  <jats:p>\n                    Images in video at 2:41 \u00a9 JNSPG, republished from Eisenberg et al\n                    <jats:sup>1<\/jats:sup>\n                    with permission.\n                  <\/jats:p>","DOI":"10.1093\/ons\/opab156","type":"journal-article","created":{"date-parts":[[2021,6,10]],"date-time":"2021-06-10T22:28:24Z","timestamp":1623364104000},"page":"E229-E230","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Extirpation of Recurrent Petrous Apex Cholesterol Granuloma Through the Zygomatic Approach: 2-Dimensional Operative Video"],"prefix":"10.1227","volume":"21","author":[{"given":"Mark","family":"Eisenberg","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Zucker School of Medicine at Hofstra\/Northwell, Manhasset, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4640-0563","authenticated-orcid":false,"given":"Walid","family":"Ibn Essayed","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ossama","family":"Al-Mefty","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,9]]},"reference":[{"issue":"5","key":"bib1-20250822","doi-asserted-by":"crossref","first-page":"822","DOI":"10.3171\/jns.1997.86.5.0822","article-title":"Petrous apex cholesterol granulomas: evolution and management","volume":"86","author":"Eisenberg","year":"1997","journal-title":"J Neurosurg"},{"issue":"1","key":"bib2-20250822","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1177\/019459989010300109","article-title":"Subcochlear approach for cholesterol granulomas of the inferior petrous apex","volume":"103","author":"Ghorayeb","year":"1990","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"4","key":"bib3-20250822","doi-asserted-by":"crossref","first-page":"792","DOI":"10.3171\/2011.11.JNS111077","article-title":"Endoscopic endonasal approach to cholesterol granulomas of the petrous apex: a series of 17 patients: clinical article","volume":"116","author":"Paluzzi","year":"2012","journal-title":"J Neurosurg"},{"issue":"9","key":"bib4-20250822","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1288\/00005537-198909000-00003","article-title":"Radiographic diagnosis, surgical treatment, and long-term follow-up of cholesterol granulomas of the petrous apex","volume":"99","author":"Thedinger","year":"1989","journal-title":"Laryngoscope"},{"issue":"4","key":"bib5-20250822","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1177\/000348947708600402","article-title":"Cystic lesions of the petrous apex: transsphenoid approach","volume":"86","author":"Montgomery","year":"1977","journal-title":"Ann Otol Rhinol Laryngol"},{"issue":"5","key":"bib6-20250822","doi-asserted-by":"crossref","first-page":"668","DOI":"10.3171\/jns.1990.73.5.0668","article-title":"Zygomatic approach to skull-base lesions","volume":"73","author":"Al-Mefty","year":"1990","journal-title":"J Neurosurg"}],"container-title":["Operative Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ons\/article-pdf\/21\/3\/E229\/39655101\/opab156.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ovid.com\/10.1093\/ons\/opab156","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:47:47Z","timestamp":1786121267000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1093\/ons\/opab156"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,10]]},"references-count":6,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.1093\/ons\/opab156","relation":{},"ISSN":["2332-4252","2332-4260"],"issn-type":[{"value":"2332-4252","type":"print"},{"value":"2332-4260","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,10]]},"assertion":[{"value":"2021-01-28","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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