Search tips
Search criteria 


Logo of skullbasesurgInstructions for AuthorsSubscribe to Skull BaseAbout Skull BaseEditorial BoardThieme Medical PublishingSkull Base An Interdisciplinary Approach ...
Skull base surgery. 1994 January; 4(1): 52–58.
PMCID: PMC1656461

Endoscopic Management of a Giant Cholesterol Cyst of the Petrous Apex


Giant cholesterol cyst (GCC) of the petrous apex is a rare clinical entity. This benign cystic lesion can cause neurologic deficits and vascular compromise by persistent growth and progressive bone destruction. Magnetic resonance imaging studies of GCC show the lesions to be hyperintense on T1-weighted sequences with progressively lower signal intensities on the first and second echoes of T2-weighted sequences. These findings are relatively specific for GCC, permitting a narrow differential diagnosis. The goal of surgery is to provide adequate drainage with the creation of a permanent fistula. The classic approaches to these lesions are the posterior fossa craniotomy and the middle fossa extradural craniotomy. The translabyrinthine approach provides wide exposure at the expense of cochlear and vestibular function. The transsphenoidal approach provides adequate drainage with hearing preservation and no craniotomy. The endoscopic, endonasal transsphenoidal approach to a 2.5 cm GCC of the petrous apex accomplished complete drainage with the creation of a fistula. Advances in endoscopic technique and instrumentation facilitated the addition of the approach to the surgeon's armamentarium. In selected cases, this approach provides adequate surgical exposure with minimal morbidity.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.9M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Graham MD, Kemink JL, Latack JT, Kartush JM. The giant cholesterol cyst of the petrous apex: a distinct clinical entity. Laryngoscope. 1985 Nov;95(11):1401–1406. [PubMed]
  • Sataloff RT, Myers DL, Roberts BR, Feldman MD, Mayer DP, Choi HY. Giant cholesterol cysts of the petrous apex. Arch Otolaryngol Head Neck Surg. 1988 Apr;114(4):451–453. [PubMed]
  • Hendershot EL, Wood JW, Bennhoff D. The middle cranial fossa approach to the petrous apex. Laryngoscope. 1976 May;86(5):658–663. [PubMed]
  • DeLozier HL, Parkins CW, Gacek RR. Mucocele of the petrous apex. J Laryngol Otol. 1979 Feb;93(2):177–180. [PubMed]
  • Montgomery WW. Cystic lesions of the petrous apex: transsphenoid approach. Ann Otol Rhinol Laryngol. 1977 Jul-Aug;86(4 Pt 1):429–435. [PubMed]
  • Metson R. Endoscopic surgery for lacrimal obstruction. Otolaryngol Head Neck Surg. 1991 Apr;104(4):473–479. [PubMed]
  • Stankiewicz JA. Cerebrospinal fluid fistula and endoscopic sinus surgery. Laryngoscope. 1991 Mar;101(3):250–256. [PubMed]
  • Schaefer SD. Endoscopic total sphenoethmoidectomy. Otolaryngol Clin North Am. 1989 Aug;22(4):727–732. [PubMed]
  • Stankiewicz JA. Complications of endoscopic intranasal ethmoidectomy. Laryngoscope. 1987 Nov;97(11):1270–1273. [PubMed]
  • Stankiewicz JA. Complications in endoscopic intranasal ethmoidectomy: an update. Laryngoscope. 1989 Jul;99(7 Pt 1):686–690. [PubMed]
  • Chole RA. Petrous apicitis: surgical anatomy. Ann Otol Rhinol Laryngol. 1985 May-Jun;94(3):251–257. [PubMed]

Articles from Skull Base Surgery are provided here courtesy of Thieme Medical Publishers