Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA.
Neurosurgery. 2013 Mar;72(1 Suppl Operative):77-86; discussion 86. doi: 10.1227/NEU.0b013e3182724354.
Cholesterol granulomas (CGs) of the petrous apex (PA) are rare, benign, expanding lesions. Surgical treatment is recommended for patients with symptomatic disease; however, the optimal surgical procedure is still controversial due to high recurrence rates. The main treatment strategy is divided into drainage and complete resection.
We advocate radical resection of the lesion by the middle fossa approach and reconstruction with a vascularized galeofascial flap.
A 10-year retrospective case review of 17 patients undergoing surgical treatment of PA CGs between 2000 and 2010 was undertaken. Operative outcomes and surgical complications were analyzed. In addition, our operative method and the related anatomy are described from cadaveric dissections.
All but 1 patient was operated on via a middle fossa approach. Using the middle fossa approach, radical resection of all PA CGs was achieved with obliteration of the cyst cavity using a vascularized flap. Important surrounding structures included the internal auditory canal, cochlea, petrous carotid artery, and abducens nerve. There was 1 death caused by internal carotid artery occlusion. No other major complications or cranial nerve deficits occurred postoperatively. Clinical recurrence occurred in 1 patient (5.9%).
Our technique of radical resection and reconstruction with a vascularized flap has the advantage of being less invasive with less cosmetic deformity and allows preservation of cranial nerve function with a low recurrence rate. Knowledge of the surgical anatomy and the characteristics of CG is prudent because important neurovascular structures may be exposed behind the CG wall due to bony erosion.
岩尖胆固醇肉芽肿（CGs）是罕见的良性、膨胀性病变。对于有症状的患者推荐手术治疗；然而，由于高复发率，最佳手术方式仍存在争议。主要的治疗策略分为引流和完全切除。
我们提倡通过中颅窝入路进行病变的根治性切除，并使用带血管的筋膜瓣进行重建。
对 2000 年至 2010 年间 17 例接受岩尖 CG 手术治疗的患者进行了 10 年回顾性病例分析。分析了手术结果和手术并发症。此外，我们还通过尸体解剖描述了手术方法和相关解剖结构。
除 1 例患者外，其余患者均通过中颅窝入路进行手术。采用中颅窝入路，使用带血管的皮瓣彻底切除所有岩尖 CG，并封闭囊腔。重要的周围结构包括内听道、耳蜗、岩骨颈动脉和外展神经。有 1 例患者因颈内动脉闭塞死亡。术后无其他严重并发症或颅神经功能障碍。1 例患者（5.9%）出现临床复发。
我们采用的根治性切除和带血管皮瓣重建技术具有微创、美容效果差的优点，并且可以保留颅神经功能，复发率低。了解手术解剖和 CG 的特征是谨慎的，因为由于骨侵蚀，重要的神经血管结构可能位于 CG 壁后面。
