Huge cholesterol granuloma of the middle ear extending to middle cranial fossa.

Cholesterol granuloma (CG) may erode into the middle ear, the mastoid bone and the petrous apex. However, aggressive erosion into the cranial cavity is extremely rare. Here we report a case of huge CG extending to the middle cranial fossa. Temporal bone computerized tomography showed a soft tissue mass which destroyed the bony plate of the posterior and middle cranial fossa. On magnetic resonance imaging, the mass revealed a high signal on both T1 and T2-weighted images. The mass compressed the middle cranial fossa without invasion into the brain. The CG was removed by extended cortical mastoidectomy. The postoperative course was uneventful and there were no neurological complications.