{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T12:16:07Z","timestamp":1779884167714,"version":"3.53.1"},"reference-count":25,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2012,4]]},"abstract":"\nObject<\/jats:title>\nThe aim of this study was to report the results in a consecutive series of patients who had undergone an endoscopic endonasal approach (EEA) for drainage of a petrous apex cholesterol granuloma (CG).<\/jats:p><\/jats:sec>\n\nMethods<\/jats:title>\nSeventeen cases with a confirmed diagnosis of petrous apex CG were identified from a database of more than 1600 patients who had undergone an EEA to skull base lesions at the authors' institution in the period from 1998 to 2011. Clinical outcomes were reviewed and compared with those in previous studies of open approaches.<\/jats:p><\/jats:sec>\n\nResults<\/jats:title>\nNine patients underwent a transclival approach and 8 patients underwent a combined transclival and infrapetrous approach. A Silastic stent was used in 11 patients (65%), a miniflap in 4 (24%), and a simple marsupialization of the cyst in 3 (18%). All symptomatic patients had partial or complete improvement of their symptoms postoperatively and at the follow-up (mean follow-up 20 months, range 3\u201367 months). Complications developed in 3 patients (18%) including epistaxis, chronic serous otitis media, eye dryness, and a transient sixth cranial nerve palsy. Two patients (12%) had a symptomatic recurrence of the cyst requiring repeat endoscopic endonasal drainage. There were no instances of internal carotid artery injuries, CSF leaks, or new hearing loss. The mean postoperative hospital stay was 2 days (range 0.7\u20134.6 days). These results were comparable with those in previous studies of open approaches to petrous apex CGs.<\/jats:p>\nThere was a strong correlation between the size of the cyst and the type of approach chosen (Rpb [point biserial correlation coefficient] = +0.67, p = 0.003359) and a very strong correlation between the degree of medial extension (defined by the V-angle) and the choice of approach (Rpb = +0.81, p < 0.0001). Based on these observations, the authors developed an algorithm for guiding the choice of the most appropriate route of drainage.<\/jats:p><\/jats:sec>\n\nConclusions<\/jats:title>\nThe EEA is a safe and effective alternative to traditional open approaches to petrous apex CGs.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2011.11.jns111077","type":"journal-article","created":{"date-parts":[[2012,1,6]],"date-time":"2012-01-06T18:02:21Z","timestamp":1325872941000},"page":"792-798","source":"Crossref","is-referenced-by-count":45,"title":["Endoscopic endonasal approach to cholesterol granulomas of the petrous apex: a series of 17 patients"],"prefix":"10.3171","volume":"116","author":[{"given":"Alessandro","family":"Paluzzi","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Gardner","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan C.","family":"Fernandez-Miranda","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos D.","family":"Pinheiro-Neto","sequence":"additional","affiliation":[{"name":"Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiago Fernando","family":"Scopel","sequence":"additional","affiliation":[{"name":"Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Koutourousiou","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl H.","family":"Snyderman","sequence":"additional","affiliation":[{"name":"Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns111077","series-title":"Skull Base","first-page":"263","article-title":"Clinicoradiological and surgical considerations in the treatment of cholesterol granuloma of the petrous pyramid","volume":"15","author":"Bockm\u00fchl","year":"2005"},{"key":"b2-jns111077","series-title":"Otol Neurotol","first-page":"383","article-title":"Magnetic resonance imaging\u2014guided biopsies of the petrous apex and petroclival region","volume":"22","author":"Bootz","year":"2001"},{"key":"b3-jns111077","series-title":"Otol Neurotol","first-page":"529","article-title":"Surgical management of petrous apex cholesterol granulomas","volume":"23","author":"Brackmann","year":"2002"},{"key":"b4-jns111077","series-title":"J Neurosurg","first-page":"625","article-title":"Cholesterol granulomas of the petrous apex: combined neurosurgical and otological 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to explain the genesis of petrous apex cholesterol granuloma","volume":"24","author":"Jackler","year":"2003"},{"key":"b14-jns111077","series-title":"J Laryngol Otol","first-page":"1005","article-title":"Large cholesterol granuloma of the petrous apex treated via subcochlear drainage","volume":"115","author":"Jaramillo","year":"2001"},{"key":"b15-jns111077","series-title":"Otolaryngol Head Neck Surg","first-page":"229","article-title":"Endoscopy-assisted surgery of the petrous apex","volume":"130","author":"Mattox","year":"2004"},{"key":"b16-jns111077","series-title":"Ann Otol Rhinol Laryngol","first-page":"429","article-title":"Cystic lesions of the petrous apex: transsphenoid approach","volume":"86","author":"Montgomery","year":"1977"},{"key":"b17-jns111077","series-title":"AJNR Am J Neuroradiol","first-page":"733","article-title":"\u2018Leave me alone\u2019 lesions of the petrous apex","volume":"19","author":"Moore","year":"1998"},{"key":"b18-jns111077","series-title":"Otol Neurotol","first-page":"522","article-title":"Management of cholesterol granulomas of the petrous apex based on clinical and radiologic evaluation","volume":"23","author":"Mosnier","year":"2002"},{"key":"b19-jns111077","series-title":"Ann Otol Rhinol Laryngol","first-page":"204","article-title":"Cholesterol granuloma involving the temporal bone","volume":"85","author":"Nager","year":"1976"},{"key":"b20-jns111077","series-title":"Acta Neurochir (Wien)","first-page":"299","article-title":"Petrous apex cholesterol granuloma treated via the endoscopic transsphenoidal approach","volume":"149","author":"Oyama","year":"2007"},{"key":"b21-jns111077","series-title":"Br J Neurosurg","first-page":"688","article-title":"Endoscopic transsphenoidal approach to petrous apex cholesterol granulomas","volume":"24","author":"Prabhu","year":"2010"},{"key":"b22-jns111077","series-title":"J Laryngol Otol","first-page":"e20","article-title":"Petrous apex cholesterol granuloma: transsphenoid endoscopic 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