Arai Yasuhiro, Suenaga Jun, Sato Mitsuru, Sano Daisuke, Yamamoto Tetsuya, Oridate Nobuhiko
Department of Otolaryngology, Head and Neck Surgery, Yokohama City University, Yokohama, Japan.
Department of Neurosurgery, Yokohama City University, Yokohama, Japan.
Pediatr Neurosurg. 2025 May 28:1-6. doi: 10.1159/000546531.
Surgical extirpation of a cholesterol granuloma in the petrous apex, located dorsal to the petrous part of the internal carotid artery (ICA), is challenging. Herein, we report a pediatric case of a cholesterol granuloma of the petrous apex treated using the endoscopic contralateral transmaxillary (CTM) approach.
A 13-year-old boy presented with a left-sided headache, slight hypoesthesia in the left V1 area, and severe neuralgia of the left auriculotemporal nerve. Magnetic resonance imaging (MRI) revealed a high-intensity mass without gadolinium enhancement. The patient's headache was unresponsive to various medications. After careful evaluation, an endoscopic CTM approach was selected for the extirpation of the granuloma. Postoperatively, the patient did not experience headache or associated neurological complications. MRI at 46 months revealed no recurrence.
The endoscopic CTM approach can be used for excising cholesterol granulomas of the petrous apex located posterior to the petrous part of the ICA without causing severe complications. This approach can be considered useful for pediatric cases in which granulomas are not accessible via the transnasal endoscopic transsphenoidal approach.
手术切除位于岩尖且位于颈内动脉（ICA）岩部背侧的胆固醇肉芽肿具有挑战性。在此，我们报告一例采用内镜对侧经上颌窦（CTM）入路治疗的小儿岩尖胆固醇肉芽肿病例。
一名13岁男孩出现左侧头痛、左侧V1区轻度感觉减退以及左侧耳颞神经严重神经痛。磁共振成像（MRI）显示一个无钆增强的高强度肿块。患者的头痛对各种药物均无反应。经过仔细评估，选择内镜CTM入路切除肉芽肿。术后，患者未出现头痛或相关神经并发症。46个月时的MRI显示无复发。
内镜CTM入路可用于切除位于ICA岩部后方的岩尖胆固醇肉芽肿，且不会引起严重并发症。对于无法通过鼻内镜经蝶窦入路处理肉芽肿的小儿病例，该入路可被认为是有用的。
