Cholesterol Granuloma Petrous Apex Revision

Video Type: CVideo
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Author: Charles Poon
Specialties: Neurosurgery, Otolaryngology
Schools: University of Cincinnati CCHMC
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Basic Info

Contributors: Ravi N. Samy, M.D., F.A.C.S (University of Cincinnati / CCHMC) and  Shawn Stevens, M.D.

Cholesterol granuloma recurrence at the petrous apex.   The patient had a prior surgery performed without stenting. Revision surgery at UC performed with double-barrel stent placement.

External Related Links:


Editor Recruited By: Ravi N. Samy, MD, FACS



Cholesterol granuloma drainage


Expanding petrous apex lesion (asymptomatic) or symptomatic (headache, retro-orbital pain, hearing loss, dizziness, facial paresis/twitching)


Only hearing ear, elderly, frail/numerous comorbidities



operating microscope, facial nerve monitoring, otologic drill, microinstruments

Preoperative Workup

anesthesia evaluation, CT scan, MRI scan, audiogram

Anatomy and Landmarks

jugular bulb, internal carotid artery, cochlear promontory


1. Advantages- outpatient procedure with minimal risk to hearing or postoperative morbidity
2. Disadvantages- can be technically challenging for a novice otologic surgeon; consider infralabyrinthine approach as well


Deafness, tympanic membrane perforation, internal carotid artery injury, jugular bulb injury

Disclosure of Conflicts

None as it relates to this video


All the listed co-authors on the video


1. Double-barrel stenting in infracochlear approach for drainage of petroux apex cholesterol granulomas. Shoman NM, Samy RN, Pensak ML. Laryngoscope. 2011 Mar;121(3):574-6. doi: 10.1002/lary.21420. Epub 2011 Jan 21. No abstract available. PMID: 21344437

Similar articles:

Petrous apex cholesterol granuloma aeration: does it matter? Castillo MP, Samy RN, Isaacson B, Roland PS.
Otolaryngol Head Neck Surg. 2008 Apr;138(4):518-22. doi: 10.1016/j.otohns.2007.12.012. PMID: 18359365

Bilateral cholesterol granulomas. Verret DJ, Samy RN. Otol Neurotol. 2005 Sep;26(5):1041-4. No abstract available. PMID: 16151356

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