Mosnier I, Wu H, Chelly H, Cyna-Gorse F, Sterkers O
Service ORL, Hôpital Beaujon, AP-HP, Faculté Xavier Bichat, Université Paris 7, 100 Bd du Général Leclerc, 92110 Clichy.
Ann Otolaryngol Chir Cervicofac. 2000 Jun;117(3):174-82.
Cholesterol granuloma of the petrous apex are cystic lesions, revealed by otologic and/or cranial nerve palsies, and diagnosed with the help of computed tomography and magnetic resonance imaging. Surgical treatment is not the complete removal of the lesion, but a conservative approach requiring drainage of the cyst and re-establishment of a correct aeration of the cavity. Three cases of cholesterol granuloma of the petrous apex were treated through a transmastoid infralabyrinthine procedure. Through a postauricular approach, a simple mastoidectomy was performed. The third portion of the facial nerve was identified. The posterior and lateral semicircular canals, and the jugular bulb were skeletonized. In two cases, a high diverticulum of the jugular bulb was impacted downwards with wax. The cystic lesion was then opened, and evacuated. The opening must be large to permit a correct aeration of the cavity and prevent stenosis of the drainage site. Hearing and the facial function were preserved in all cases. In conclusion, conservative approach to cholesterol granuloma of the petrous apex provides satisfactory drainage of this intrapetrous deep seated lesion with preservation of hearing and facial nerve function.
岩尖胆固醇肉芽肿是一种囊性病变，可通过耳科症状和/或颅神经麻痹发现，并借助计算机断层扫描和磁共振成像进行诊断。手术治疗并非完全切除病变，而是一种保守方法，需要对囊肿进行引流并重新建立腔隙的正确通气。三例岩尖胆固醇肉芽肿患者通过经乳突迷路下手术进行治疗。通过耳后入路，进行了简单的乳突切除术。识别出面神经的第三段。后半规管、外侧半规管和颈静脉球被暴露。在两例病例中，颈静脉球的高位憩室被用蜡向下挤压。然后打开囊性病变并进行排空。开口必须足够大，以保证腔隙的正确通气并防止引流部位狭窄。所有病例的听力和面神经功能均得以保留。总之，对岩尖胆固醇肉芽肿采取保守方法可对这种岩内深部病变进行令人满意的引流，同时保留听力和面神经功能。
