Cholesterol Granuloma of the Petrous Apex: Establishment of a Drainage Route into the Superior Tympanic Cavity —Technical Note—

  • KAMIGUCHI Hiroyuki
    Departments of Neurosurgery, School of Medicine, Keio University
  • KAWASE Takeshi
    Departments of Neurosurgery, School of Medicine, Keio University
  • TOYA Shigeo
    Departments of Neurosurgery, School of Medicine, Keio University
  • INOUE Yasuhiro
    Departments of Otorhinolaryngology, School of Medicine, Keio University

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A 40-year-old male presented with a cholesterol granuloma of the petrous apex manifesting as progressive hearing loss and tinnitus. The lesion was treated via an extradural middle cranial fossa approach employing a new procedure to establish a drainage pathway into the superior tympanic cavity which preserved his hearing. The pathway was formed by a groove 5 mm wide and deep in the anterolateral aspect of the petrous bone, crossing the major petrosal nerve and carotid artery, running around the cochlea, crossing the tensor tympanic muscle, and entering the superior tympanic cavity above the orifice of the eustachian tube. This procedure is easy to perform without special techniques.

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