Surgical management of petrous apex cholesterol granulomas by an infralabyrinthine approach: our experience with fourteen cases

Cholesterol granulomas represent 40% of benign lesions developed within the petrous apex.1 Most of them are asymptomatic and do not require any treatment.2 When they involve adjacent structures such as the inner ear, the internal auditory meatus, the cranial nerves, or when they are painful, surgical management is required although this is challenging because of the position of the lesion and the high rate of recurrence. Leaving a permanent aerated pathway is mandatory to avoid closure of the cavity and recurrence, which occurs in, on average, 20% of cases.3 Although the exact pathogenesis of cholesterol granulomas is unclear, it seems that a chronic inflammatory reaction is caused by a lack of ventilation.4, 5 This study aimed to report the experiences of a tertiary referral centre in the management of cholesterol granuloma of the petrous apex by an infralabyrinthine approach, focusing on the progress achieved in recent years