{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T05:46:30Z","timestamp":1791611190963,"version":"4.3.4"},"reference-count":80,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2014,10]]},"abstract":"<jats:sec>\n                    <jats:title>Object<\/jats:title>\n                    <jats:p>Endoscopic endonasal treatment of petrous apex cholesterol granulomas allows for a natural drainage pathway into the nasopharynx. Because of the limited number of case series in the literature, there is limited evidence of recurrence rates and outcomes following endoscopic endonasal management. The purpose of this study was to determine the surgical outcomes of endoscopic endonasal approaches in the treatment of cholesterol granulomas of the petrous apex.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic literature review was performed using PubMed for articles published from January 1980 to April 2014 to identify all studies reporting outcomes for endoscopic endonasal surgical management of cholesterol granulomas of the petrous apex. Operative approach, use of a stent, symptom outcome, restenosis, cyst recurrence, reoperation, and complications were extracted from included studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 53 patient cases were included from 22 relevant studies. The mean age was 41 years, and 26 patients (49%) were female. Stents were used in 45.1% of cases. Symptom resolution or improvement was seen in 98.6% of cases at follow-up (mean follow-up 20 months). Complications were reported in 13.2% of cases, with the most common complication being epistaxis. Restenosis on follow-up office endoscopic examination occurred in 9 of 45 cases (20.0%). Only 4 of these restenosis cases resulted in symptomatic cyst recurrence, resulting in an overall recurrence rate of 7.5%. The mean time from surgery to cyst recurrence was 13.5 months. The rate of symptomatic cyst recurrence was 10.7% in cases without the use of a stent compared with 4.3% in cases with stent placement (p = 0.6).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Based on current literature, endoscopic endonasal approaches result in a high rate of symptom improvement or resolution. Complication rates are lower than prior case series that have utilized open approaches. Asymptomatic restenosis can be managed conservatively, since it is associated with symptomatic cyst recurrence less than half of the time. This study revealed a nonsignificant trend toward a decrease in symptomatic cyst recurrence when a stent was used, but further work is needed to clarify its impact.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2014.7.focus14344","type":"journal-article","created":{"date-parts":[[2014,10,1]],"date-time":"2014-10-01T04:43:47Z","timestamp":1412138627000},"page":"E14","source":"Crossref","is-referenced-by-count":45,"title":["Surgical outcomes after endoscopic management of cholesterol granulomas of the petrous apex: a systematic review"],"prefix":"10.3171","volume":"37","author":[{"given":"Danielle F.","family":"Eytan","sequence":"first","affiliation":[{"name":"Cleveland Clinic Lerner College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Varun R.","family":"Kshettry","sequence":"additional","affiliation":[{"name":"Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raj","family":"Sindwani","sequence":"additional","affiliation":[{"name":"Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic"},{"name":"Minimally Invasive Cranial Base & Pituitary Surgery Program, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Troy D.","family":"Woodard","sequence":"additional","affiliation":[{"name":"Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic"},{"name":"Minimally Invasive Cranial Base & Pituitary Surgery Program, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pablo F.","family":"Recinos","sequence":"additional","affiliation":[{"name":"Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic"},{"name":"Minimally Invasive Cranial Base & Pituitary Surgery Program, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-0370014","series-title":"J Laryngol Otol","first-page":"236","article-title":"The effects of exclusion of air from pneumatized bones","volume":"80","author":"Beaumont","year":"1966"},{"key":"b2-0370014","series-title":"J Neurosurg","first-page":"1215","article-title":"Endoscopic balloon dilation as an adjunct to extended endoscopic approaches to the skull base. Case report","volume":"116","author":"Bedrosian","year":"2012"},{"key":"b3-0370014","series-title":"Otol Neurotol","first-page":"529","article-title":"Surgical management of petrous apex cholesterol granulomas","volume":"23","author":"Brackmann","year":"2002"},{"key":"b4-0370014","series-title":"J Neurosurg","first-page":"625","article-title":"Cholesterol granulomas of the petrous apex: combined neurosurgical and otological management","volume":"85","author":"Brodkey","year":"1996"},{"key":"b5-0370014","series-title":"Surg Neurol","first-page":"64","article-title":"A keyhole middle fossa approach to large cholesterol granulomas of the petrous apex","volume":"53","author":"Cristante","year":"2000"},{"key":"b6-0370014","series-title":"J Laryngol Otol","first-page":"169","article-title":"Endoscopic trans-sphenoidal removal of cholesterol granuloma of the petrous apex: case report and literature review","volume":"125","author":"Dhanasekar","year":"2011"},{"key":"b7-0370014","series-title":"Otol Neurotol","first-page":"939","article-title":"Image-guided endoscopic transsphenoidal drainage of select petrous apex cholesterol granulomas","volume":"24","author":"DiNardo","year":"2003"},{"key":"b8-0370014","series-title":"S Afr J Surg","first-page":"94","article-title":"Endoscopic trans-sphenoidal drainage of petrous apex cholesterol granulomas","volume":"48","author":"Edkins","year":"2010"},{"key":"b9-0370014","series-title":"J Neurosurg","first-page":"822","article-title":"Petrous apex cholesterol granulomas: evolution and management","volume":"86","author":"Eisenberg","year":"1997"},{"key":"b10-0370014","series-title":"Eur Arch Otorhinolaryngol","first-page":"1747","article-title":"Transnasal endoscopic management of petrous apex and clivus selected lesions","volume":"270","author":"Emanuelli","year":"2013"},{"key":"b11-0370014","series-title":"Laryngoscope","first-page":"1286","article-title":"The positive pressure of cholesterol granuloma idiopathic blue eardrum. Differential diagnosis","volume":"91","author":"Farrior","year":"1981"},{"key":"b12-0370014","series-title":"Skull Base Surg","first-page":"52","article-title":"Endoscopic management of a giant cholesterol cyst of the petrous apex","volume":"4","author":"Fucci","year":"1994"},{"key":"b13-0370014","series-title":"Clin Otolaryngol","first-page":"38","article-title":"Endoscopic transsphenoidal surgery for cholesterol granulomas involving the petrous apex","volume":"33","author":"Georgalas","year":"2008"},{"key":"b14-0370014","series-title":"Laryngoscope","first-page":"659","article-title":"Cholesterol granuloma of the petrous apex","volume":"95","author":"Gherini","year":"1985"},{"key":"b15-0370014","series-title":"Ann Otol Rhinol Laryngol","first-page":"181","article-title":"Cholesterol cysts of the temporal bone: diagnosis and treatment","volume":"100","author":"Goldofsky","year":"1991"},{"key":"b16-0370014","series-title":"Laryngoscope","first-page":"1401","article-title":"The giant cholesterol cyst of the petrous apex: a distinct clinical entity","volume":"95","author":"Graham","year":"1985"},{"key":"b17-0370014","series-title":"Otolaryngol Head Neck Surg","first-page":"91","article-title":"Transsphenoid endoscopic management of petrous apex cholesterol granuloma","volume":"114","author":"Griffith","year":"1996"},{"key":"b18-0370014","series-title":"Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence.","author":"Howick","year":"2014"},{"key":"b19-0370014","series-title":"Skull Base","first-page":"375","article-title":"Endoscopic endonasal approaches to management of cholesterol granuloma of the petrous apex","volume":"20","author":"Jaberoo","year":"2010"},{"key":"b20-0370014","series-title":"Otol Neurotol","first-page":"96","article-title":"A new theory to explain the genesis of petrous apex cholesterol granuloma","volume":"24","author":"Jackler","year":"2003"},{"key":"b21-0370014","series-title":"Ear Nose Throat J","first-page":"E23","article-title":"Petrous apex cholesterol granuloma involving the sphenoid sinus","volume":"90","author":"Korbmacher","year":"2011"},{"issue":"1 Suppl Operative","key":"b22-0370014","series-title":"Neurosurgery","first-page":"77","article-title":"Middle fossa approach for total resection of petrous apex cholesterol granulomas: use of vascularized galeofascial flap preventing recurrence","volume":"72","author":"Kusumi","year":"2013"},{"key":"b23-0370014","series-title":"Skull Base Rep","first-page":"27","article-title":"Endoscopic endonasal management of recurrent petrous apex cholesterol granuloma","volume":"1","author":"McLaughlin","year":"2011"},{"key":"b24-0370014","series-title":"Int J Pediatr Otorhinolaryngol","first-page":"165","article-title":"Image-guided transphenoidal drainage of a cholesterol granuloma of the petrous apex in a child","volume":"57","author":"Michaelson","year":"2001"},{"key":"b25-0370014","series-title":"PLoS Med","first-page":"e1000097","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"6","author":"Moher","year":"2009"},{"key":"b26-0370014","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":"b27-0370014","series-title":"Acta Otolaryngol Suppl","first-page":"3","article-title":"Pneumatization of the bone and environmental factors; experimental studies on chick humerus","volume":"133","author":"Ojala","year":"1957"},{"key":"b28-0370014","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":"b29-0370014","series-title":"J Neurosurg","first-page":"792","article-title":"Endoscopic endonasal approach to cholesterol granulomas of the petrous apex: a series of 17 patients. 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Case report","volume":"116","author":"Bedrosian","year":"2012"},{"key":"b3-0370014","series-title":"Otol Neurotol","first-page":"529","article-title":"Surgical management of petrous apex cholesterol granulomas","volume":"23","author":"Brackmann","year":"2002"},{"key":"b4-0370014","series-title":"J Neurosurg","first-page":"625","article-title":"Cholesterol granulomas of the petrous apex: combined neurosurgical and otological management","volume":"85","author":"Brodkey","year":"1996"},{"key":"b5-0370014","series-title":"Surg Neurol","first-page":"64","article-title":"A keyhole middle fossa approach to large cholesterol granulomas of the petrous apex","volume":"53","author":"Cristante","year":"2000"},{"key":"b6-0370014","series-title":"J Laryngol Otol","first-page":"169","article-title":"Endoscopic trans-sphenoidal removal of cholesterol granuloma of the petrous apex: case report and literature review","volume":"125","author":"Dhanasekar","year":"2011"},{"key":"b7-0370014","series-title":"Otol Neurotol","first-page":"939","article-title":"Image-guided endoscopic transsphenoidal drainage of select petrous apex cholesterol granulomas","volume":"24","author":"DiNardo","year":"2003"},{"key":"b8-0370014","series-title":"S Afr J Surg","first-page":"94","article-title":"Endoscopic trans-sphenoidal drainage of petrous apex cholesterol granulomas","volume":"48","author":"Edkins","year":"2010"},{"key":"b9-0370014","series-title":"J Neurosurg","first-page":"822","article-title":"Petrous apex cholesterol granulomas: evolution and management","volume":"86","author":"Eisenberg","year":"1997"},{"key":"b10-0370014","series-title":"Eur Arch Otorhinolaryngol","first-page":"1747","article-title":"Transnasal endoscopic management of petrous apex and clivus selected lesions","volume":"270","author":"Emanuelli","year":"2013"},{"key":"b11-0370014","series-title":"Laryngoscope","first-page":"1286","article-title":"The positive pressure of cholesterol granuloma idiopathic blue eardrum. Differential diagnosis","volume":"91","author":"Farrior","year":"1981"},{"key":"b12-0370014","series-title":"Skull Base Surg","first-page":"52","article-title":"Endoscopic management of a giant cholesterol cyst of the petrous apex","volume":"4","author":"Fucci","year":"1994"},{"key":"b13-0370014","series-title":"Clin Otolaryngol","first-page":"38","article-title":"Endoscopic transsphenoidal surgery for cholesterol granulomas involving the petrous apex","volume":"33","author":"Georgalas","year":"2008"},{"key":"b14-0370014","series-title":"Laryngoscope","first-page":"659","article-title":"Cholesterol granuloma of the petrous apex","volume":"95","author":"Gherini","year":"1985"},{"key":"b15-0370014","series-title":"Ann Otol Rhinol Laryngol","first-page":"181","article-title":"Cholesterol cysts of the temporal bone: diagnosis and treatment","volume":"100","author":"Goldofsky","year":"1991"},{"key":"b16-0370014","series-title":"Laryngoscope","first-page":"1401","article-title":"The giant cholesterol cyst of the petrous apex: a distinct clinical entity","volume":"95","author":"Graham","year":"1985"},{"key":"b17-0370014","series-title":"Otolaryngol Head Neck Surg","first-page":"91","article-title":"Transsphenoid endoscopic management of petrous apex cholesterol granuloma","volume":"114","author":"Griffith","year":"1996"},{"key":"b18-0370014","series-title":"Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence.","author":"Howick","year":"2014"},{"key":"b19-0370014","series-title":"Skull Base","first-page":"375","article-title":"Endoscopic endonasal approaches to management of cholesterol granuloma of the petrous apex","volume":"20","author":"Jaberoo","year":"2010"},{"key":"b20-0370014","series-title":"Otol Neurotol","first-page":"96","article-title":"A new theory to explain the genesis of petrous apex cholesterol granuloma","volume":"24","author":"Jackler","year":"2003"},{"key":"b21-0370014","series-title":"Ear Nose Throat J","first-page":"E23","article-title":"Petrous apex cholesterol granuloma involving the sphenoid sinus","volume":"90","author":"Korbmacher","year":"2011"},{"issue":"1 Suppl Operative","key":"b22-0370014","series-title":"Neurosurgery","first-page":"77","article-title":"Middle fossa approach for total resection of petrous apex cholesterol granulomas: use of vascularized galeofascial flap preventing recurrence","volume":"72","author":"Kusumi","year":"2013"},{"key":"b23-0370014","series-title":"Skull Base Rep","first-page":"27","article-title":"Endoscopic endonasal management of recurrent petrous apex cholesterol granuloma","volume":"1","author":"McLaughlin","year":"2011"},{"key":"b24-0370014","series-title":"Int J Pediatr Otorhinolaryngol","first-page":"165","article-title":"Image-guided transphenoidal drainage of a cholesterol granuloma of the petrous apex in a child","volume":"57","author":"Michaelson","year":"2001"},{"key":"b25-0370014","series-title":"PLoS Med","first-page":"e1000097","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"6","author":"Moher","year":"2009"},{"key":"b26-0370014","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":"b27-0370014","series-title":"Acta Otolaryngol Suppl","first-page":"3","article-title":"Pneumatization of the bone and environmental factors; experimental studies on chick humerus","volume":"133","author":"Ojala","year":"1957"},{"key":"b28-0370014","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":"b29-0370014","series-title":"J Neurosurg","first-page":"792","article-title":"Endoscopic endonasal approach to cholesterol granulomas of the petrous apex: a series of 17 patients. 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