The petrous apex is a pyramid shaped portion of the temporal bone that is interposed between the sphenoid and occipital bones of the skull base. It is located approximately three to four centimeters deep to the middle ear.<\/p>\n\n\n\n
Cholesterol granulomas are rare, benign (non-cancerous) cysts produced either in response to air cells of the petrous apex being blocked or because spontaneous bleeding from adjacent marrow spaces incites inflammation. In either case, breakdown products of blood (including cholesterol) accumulate in the air cells, the immune system treats this cholesterol debris as foreign, and an enlarging granuloma results.<\/p>\n\n\n\n
Cholesterol granulomas of the petrous apex are expansile and can be dangerous due to their proximity to the middle ear, facial nerve, vestibulocochlear nerve (the nerve that sends hearing and balance information from the inner ear to the brain), the trigeminal nerve, the petrous carotid artery, the inner ear, and intracranial contents. Early symptoms include hearing loss,\u00a0tinnitus<\/a>, dizziness, facial weakness, sensory abnormalities of the face and vague headaches that seem worst immediately behind the eyes. If left untreated, more serious patient compromise may result from permanent cranial nerve or inner ear damage as well as from destruction of the temporal bone.<\/p>\n\n\n\n Diagnostic workup for petrous apex lesions includes a comprehensive audiogram (hearing test) and temporal bone imaging \u2013 using both CT and MRI technologies. Once a cholesterol granuloma is discovered, it may be observed if small and asymptomatic. Should surgery be required, several approaches to the petrous apex may be used including the hypotympanic\/infracochlear approach, the transotic approach and the middle fossa approach. Occasionally, the hypotympanic\/ infracochlear approach can be performed endoscopically, minimizing use of external incisions. Some petrous apex granulomas can even be reached through the nose; if such were the case, appropriate referral to a skull base rhinologist would be provided. Each patient case is different, depending on the location of the cholesterol granulomas and the severity of symptoms experienced.<\/p>\n\n\n\nWhy Choose Us<\/h2>\n\n\n\n