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Skull base surgery. 1992 October; 2(4): 204–206.
PMCID: PMC1656383

Periaqueductal Approach to Cholesterol Granulomas of the Petrous Apex


The periaqueductal approach for the drainage of cholesterol granulomas of the petrons apex is described. As with previously reported approaches, the periaqueductal approach takes advantage of the high pneumatization of the temporal bone in this disease. It requires dissection of the supralabyrinthine air cell tract as well as air cells medial to the posterior semicircular canal. This requires a circumferential bony dissection, skeletonization, and preservation of the vestibular aqueduct and the identification of the internal auditory canal. This periaqueductal approach preserves hearing and provides an alternative to the infralabyrinthine and infracochlear approaches when their use is precluded by variations in the temporal bone.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Gherini SG, Brackmann DE, Lo WW, Solti-Bohman LG. Cholesterol granuloma of the petrous apex. Laryngoscope. 1985 Jun;95(6):659–664. [PubMed]
  • Ghorayeb BY, Jahrsdoerfer RA. Subcochlear approach for cholesterol granulomas of the inferior petrous apex. Otolaryngol Head Neck Surg. 1990 Jul;103(1):60–65. [PubMed]
  • Giddings NA, Brackmann DE, Kwartler JA. Transcanal infracochlear approach to the petrous apex. Otolaryngol Head Neck Surg. 1991 Jan;104(1):29–36. [PubMed]
  • House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg. 1985 Apr;93(2):146–147. [PubMed]
  • Chole RA. Petrous apicitis: surgical anatomy. Ann Otol Rhinol Laryngol. 1985 May-Jun;94(3):251–257. [PubMed]

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