Wong Eugene Hung Chih, Lim Chee Chean, Ong Cheng Ai, Narayanan Prepageran
Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia.
Department of Otorhinolaryngology - Head and Neck Surgery, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia.
Int J Surg Case Rep. 2020;72:587-589. doi: 10.1016/j.ijscr.2020.06.086. Epub 2020 Jun 26.
Cholesterol granuloma (CG) is a rare entity but is the commonest lesion in the petrous apex. They are associated with chronic ear disease and previous temporal bone surgery. While bone wax has been known to cause foreign body reaction due to its non-resorbable property in the mastoid, it has not been documented to cause CG formation.
We described a 43 years old male who presented with a right mastoid swelling, nine years after a right retro-sigmoid craniotomy and excision for a cerebellopontine angle meningioma. He also had multiple cranial neuropathies involving trigeminal, facial and vestibulocochlear nerves. Temporal bone CT and MRI showed features suggestive of cholesterol granuloma with extensive bony erosions. He was treated with surgical excision and drainage where bone wax residues were found intraoperatively. Histopathological analysis of the lesion confirmed the diagnosis of cholesterol granuloma. Post-operatively, the mastoid swelling resolved and his recovery was uneventful.
Our case showed that CG could manifest as a complication of bone wax usage in a neurosurgical procedure. Even though further study is needed to draw a definitive conclusion on this theory, we believe this paper will contribute to the current literature as it is the only reported case of cholesterol granuloma with bone wax as the possible causative agent. This is important so that surgeons are aware of this potential complication and use this haemostatic agent more judiciously.
胆固醇肉芽肿（CG）是一种罕见病症，但却是岩尖最常见的病变。它们与慢性耳部疾病及既往颞骨手术有关。虽然骨蜡因其在乳突中不可吸收的特性而已知会引起异物反应，但尚未有文献记载其会导致胆固醇肉芽肿形成。
我们描述了一名43岁男性，在因桥小脑角脑膜瘤行右侧乙状窦后开颅手术并切除术后九年，出现右侧乳突肿胀。他还患有涉及三叉神经、面神经和前庭蜗神经的多发性颅神经病变。颞骨CT和MRI显示出提示胆固醇肉芽肿伴广泛骨质侵蚀的特征。对其进行了手术切除及引流，术中发现了骨蜡残留。病变的组织病理学分析证实了胆固醇肉芽肿的诊断。术后，乳突肿胀消退，他恢复顺利。
我们的病例表明，胆固醇肉芽肿可表现为神经外科手术中使用骨蜡的一种并发症。尽管需要进一步研究来就此理论得出明确结论，但我们相信本文将为现有文献做出贡献，因为这是唯一一例报道的以骨蜡为可能致病因素的胆固醇肉芽肿病例。这很重要，以便外科医生意识到这种潜在并发症，并更谨慎地使用这种止血剂。
