Brodkey J A, Robertson J H, Shea J J, Gardner G
Department of Neurosurgery, University of Tennessee, College of Medicine, Memphis, USA.
J Neurosurg. 1996 Oct;85(4):625-33. doi: 10.3171/jns.1996.85.4.0625.
Cholesterol granulomas of the head are relatively rare. Isolated lesions of the cerebellopontine angle are even more uncommon. In this report, 17 cases of petrous apex cholesterol granulomas are presented and management is discussed. Symptoms at presentation included dizziness (14 patients), pressure (nine patients), tinnitus (eight patients), hearing loss (eight patients), otalgia (six patients), headache (six patients), nausea (three patients), drainage from ear (two patients), facial pain (two patients), seizure (two patients), lightheadedness (one patient), hemifacial spasm (one patient), and facial numbness (one patient). Six cases were managed without surgery and 11 patients underwent operative procedures. The approaches used included the infralabyrinthine (eight patients), transcanal-infracochlear (two patients), and translabyrinthine (one patient). The mean follow-up period for all cases was 29.5 months. Of those patients managed without surgery, symptoms improved in all except one, whose tinnitus was slightly worse. Of surgically treated patients, symptoms improved or remained the same except in one with worsened dizziness. There were nine patients with hearing present presurgery and seven whose hearing was preserved postsurgery. The authors present a case that was managed at another center where an attempt at surgical resection through a subtemporal middle fossa approach was unsuccessful. This lesion was successfully treated using an infralabyrinthine approach with drainage into the mastoid cavity. Cholesterol granulomas of the petrous apex can be managed without surgery when symptoms are stable or improve. Otherwise, a transmastoid extradural approach with simple drainage into the mastoid sinus or middle ear produces symptomatic improvement with low morbidity. Resection of petrous apex cholesterol granulomas is not necessary.
头部胆固醇肉芽肿相对少见。孤立的桥小脑角病变更为罕见。在本报告中，呈现了17例岩尖胆固醇肉芽肿病例并讨论了其治疗方法。就诊时的症状包括头晕（14例患者）、压迫感（9例患者）、耳鸣（8例患者）、听力损失（8例患者）、耳痛（6例患者）、头痛（6例患者）、恶心（3例患者）、耳内引流（2例患者）、面部疼痛（2例患者）、癫痫发作（2例患者）、头晕（1例患者）、半面痉挛（1例患者）和面部麻木（1例患者）。6例患者未经手术治疗，11例患者接受了手术。采用的手术入路包括迷路下（8例患者）、经耳道-耳蜗下（2例患者）和经迷路（1例患者）。所有病例的平均随访期为29.5个月。在未经手术治疗的患者中，除1例耳鸣稍有加重外，其他患者症状均有改善。在接受手术治疗的患者中，除1例头晕加重外，其他患者症状均有改善或维持不变。术前有9例患者有听力，术后有7例患者听力得以保留。作者介绍了另一中心处理的1例病例，通过颞下中颅窝入路进行手术切除的尝试未成功。该病变通过迷路下入路并引流至乳突腔成功治疗。当症状稳定或改善时，岩尖胆固醇肉芽肿可无需手术治疗。否则，采用经乳突硬膜外入路简单引流至乳突窦或中耳可使症状改善且发病率低。切除岩尖胆固醇肉芽肿并非必要。
