{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T04:53:15Z","timestamp":1762059195903,"version":"build-2065373602"},"reference-count":17,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2022,7,24]],"date-time":"2022-07-24T00:00:00Z","timestamp":1658620800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objective: Petrous apex cholesterol granuloma (PACG) is a lesion that can give rise to different symptoms, and correlations with etiopathology are ambiguous. The aim of this study is to analyze the association between PACG symptoms and radiological findings at presentation, in order to establish a reproduceable pre-operative radiological evaluation and guide the surgical indication. Methods: PACG patients were collected in two tertiary care hospitals. All cases underwent CT\/MRI to evaluate the cyst localization and erosion of surrounding structures. Typical and atypical symptoms were then analyzed and compared to radiologic findings established in accordance with the literature. Results: Twenty-nine patients were recruited; the most common symptoms were headache (69%), diplopia (20.7%) and fainting (24.1%), an atypical clinical manifestation related to jugular tubercle involvement. Significant associations between symptoms and radiologic findings were noted in terms of headache and temporal lobe compression (p = 0.04), fainting and jugular tubercle erosion (p &lt; 0.001), vestibular symptoms and internal auditory canal erosion (p = 0.02), facial paresthesia and Meckel\u2019s cave compression (p = 0.03), diplopia and Dorello canal involvement (p = 0.001), and tinnitus and cochlear basal turn erosion (p &lt; 0.001). All patients were treated via an endoscopic\u2013endonasal approach, in which extension was tailored to each case. At a median follow-up of 46 months, 93.1% of patients experienced resolution of symptoms. Conclusions: This clinico-radiological series demonstrates associations between symptoms and anatomical subsites involved with PACG. Hence, it may guide the surgeon at the time of surgical decision, since it asserts that typical and atypical symptoms are actually related to PACG.<\/jats:p>","DOI":"10.3390\/jcm11154297","type":"journal-article","created":{"date-parts":[[2022,7,24]],"date-time":"2022-07-24T22:49:02Z","timestamp":1658702942000},"page":"4297","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Typical and Atypical Symptoms of Petrous Apex Cholesterol Granuloma: Association with Radiological Findings"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4805-4908","authenticated-orcid":false,"given":"Alessandro","family":"Vinciguerra","sequence":"first","affiliation":[{"name":"Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisi\u00e8re, 75010 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3678-9088","authenticated-orcid":false,"given":"Mario","family":"Turri-Zanoni","sequence":"additional","affiliation":[{"name":"Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Via Guicciardini 9, 21100 Varese, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"Verillaud","sequence":"additional","affiliation":[{"name":"Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisi\u00e8re, 75010 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8214-7983","authenticated-orcid":false,"given":"Jean-Pierre","family":"Guichard","sequence":"additional","affiliation":[{"name":"Service de Neuroradiologie, AP-HP, H\u00f4pital Lariboisi\u00e8re, 75010 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luca","family":"Spirito","sequence":"additional","affiliation":[{"name":"Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Via Guicciardini 9, 21100 Varese, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Apostolos","family":"Karligkiotis","sequence":"additional","affiliation":[{"name":"Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Via Guicciardini 9, 21100 Varese, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Castelnuovo","sequence":"additional","affiliation":[{"name":"Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Via Guicciardini 9, 21100 Varese, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philippe","family":"Herman","sequence":"additional","affiliation":[{"name":"Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisi\u00e8re, 75010 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1016\/j.otc.2011.06.005","article-title":"Cholesterol granuloma of the petrous apex","volume":"44","author":"Gore","year":"2011","journal-title":"Otolaryngol. Clin. N. Am."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1016\/j.otc.2007.03.003","article-title":"Lesions of the petrous apex: Diagnosis and management","volume":"40","author":"Isaacson","year":"2007","journal-title":"Otolaryngol. Clin. N. Am."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1097\/MAO.0000000000001268","article-title":"Long-term Symptom-specific Outcomes for Patients with Petrous Apex Cholesterol Granulomas: Surgery Versus Observation","volume":"38","author":"Stevens","year":"2017","journal-title":"Otol. Neurotol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1714","DOI":"10.1097\/MAO.0000000000000862","article-title":"The Natural History and Management of Petrous Apex Cholesterol Granulomas","volume":"36","author":"Sweeney","year":"2015","journal-title":"Otol. Neurotol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1055\/s-0034-1396600","article-title":"Cholesterol Granuloma of the Petrous Apex: A 5-Year Review of Radiology Reports with Follow-Up of Progression and Treatment","volume":"76","author":"Raghavan","year":"2015","journal-title":"J. Neurol. Surg. B Skull Base"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"193","DOI":"10.5152\/iao.2019.5859","article-title":"Cholesterol Granulomas: A Comparative Meta-Analysis of Endonasal Endoscopic versus Open Approaches to the Petrous Apex","volume":"15","author":"Tabet","year":"2019","journal-title":"J. Int. Adv. Otol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1017\/S0022215113000091","article-title":"Petrous apex cholesterol granuloma: Pictorial review of radiological considerations in diagnosis and surgical histopathology","volume":"127","author":"Hoa","year":"2013","journal-title":"J. Laryngol. Otol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1271","DOI":"10.1007\/s00405-020-06203-4","article-title":"Functional treatment of temporal bone chondroblastoma: Retrospective analysis of 3 cases","volume":"278","author":"Vinciguerra","year":"2021","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1097\/00129492-200207000-00022","article-title":"Management of cholesterol granulomas of the petrous apex based on clinical and radiologic evaluation","volume":"23","author":"Mosnier","year":"2002","journal-title":"Otol. Neurotol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1097\/00129492-200207000-00023","article-title":"Surgical management of petrous apex cholesterol granulomas","volume":"23","author":"Brackmann","year":"2002","journal-title":"Otol. Neurotol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"753","DOI":"10.3171\/jns.2006.105.5.753","article-title":"Jugular tubercle: Morphometric analysis and surgical significance","volume":"105","author":"Mintelis","year":"2006","journal-title":"J. Neurosurg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1476","DOI":"10.1093\/eurheartj\/14.11.1476","article-title":"Parapharyngeal space lesions syncope-syndrome. A newly proposed reflexogenic cardiovascular syndrome","volume":"14","author":"Cicogna","year":"1993","journal-title":"Eur. Heart J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/S1470-2045(05)70172-8","article-title":"Syncope due to nasopharyngeal carcinoma","volume":"6","author":"Kaza","year":"2005","journal-title":"Lancet Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"E8","DOI":"10.3171\/2012.12.FOCUS12391","article-title":"Current neurosurgical management of glossopharyngeal neuralgia and technical nuances for microvascular decompression surgery","volume":"34","year":"2013","journal-title":"Neurosurg. Focus"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2639","DOI":"10.1002\/lary.24170","article-title":"A novel endoscopic technique for long-term patency of cholesterol granulomas of the petrous apex","volume":"123","author":"Terranova","year":"2013","journal-title":"Laryngoscope"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"E2513","DOI":"10.1002\/lary.29432","article-title":"Mucosal Grafting Reduces Recurrence After Endonasal Surgery of Petrous Apex Cholesterol Granulomas","volume":"131","author":"Patel","year":"2021","journal-title":"Laryngoscope"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"E14","DOI":"10.3171\/2014.7.FOCUS14344","article-title":"Surgical outcomes after endoscopic management of cholesterol granulomas of the petrous apex: A systematic review","volume":"37","author":"Eytan","year":"2014","journal-title":"Neurosurg. Focus"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/15\/4297\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:55:48Z","timestamp":1760140548000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/15\/4297"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,24]]},"references-count":17,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["jcm11154297"],"URL":"https:\/\/doi.org\/10.3390\/jcm11154297","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2022,7,24]]}}}