Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia.
School of Medicine, University of Zagreb, Zagreb, Croatia.
ORL J Otorhinolaryngol Relat Spec. 2023;85(3):172-176. doi: 10.1159/000530054. Epub 2023 Apr 5.
Cholesterol granuloma of the petrous bone is a foreign body giant cell reaction to cholesterol deposits with symptoms including hearing loss, vestibular dysfunction, and cranial nerve deficit as a result of cystic mass compression. Surgical treatment is often difficult to plan due to limited access to the lesion and possible injury to surrounding structures. We report on a case of petrous apex cholesterol granuloma drainage through an infracochlear approach. A 27-year-old female patient presented with acute diplopia due to left-sided abducens paralysis. Multislice computed tomography (MSCT) and magnetic resonance (MR) imaging described a 3.5-cm well-marginated lesion in petrous bone apex, compressing the left abducens nerve at the point of entry into the cavernous sinus, corresponding to cholesterol granuloma. The patients was surgically treated through a transcanal infracochlear approach, since preserving the external and middle ear conduction mechanisms was paramount for the patient. The patient was discharged on the second postoperative day and diplopia resolved within 5 days postoperatively. Six months after the surgery, her hearing on the left side is normal, and she remains symptom-free. This case underpins the value of preoperative planning when approaching the petrous apex, an anatomically complex area due to abundance of important neurovascular structures crowded in a narrow and confined region.
岩骨胆脂瘤是胆固醇沉积引发的异物巨细胞反应，其症状包括因囊性肿块压迫而导致听力损失、前庭功能障碍和颅神经缺陷。由于病变部位难以接近，且可能损伤周围结构，手术治疗往往难以规划。我们报告了一例通过经耳蜗下入路引流岩骨尖胆脂瘤的病例。一名 27 岁女性患者因左侧外展神经麻痹而出现急性复视。多层螺旋 CT（MSCT）和磁共振成像（MR）描述了一个 3.5 厘米边界清楚的岩骨尖病变，压迫了左侧进入海绵窦的展神经，符合胆脂瘤的表现。由于保护患者的外耳和中耳传导机制至关重要，该患者通过经耳蜗下入路进行了手术治疗。患者于术后第 2 天出院，术后 5 天复视缓解。术后 6 个月，她左侧听力正常，且无症状。该病例强调了在接近解剖结构复杂的岩骨尖时进行术前规划的重要性，因为此处有大量重要的神经血管结构拥挤在一个狭窄而受限的区域。
