Endoscopic endonasal approach with pedicled nasoseptal flap for cholesterol granulomas of the petrous apex

Objectives Cholesterol granulomas of the petrous apex are rare expansile lesions that have traditionally been managed through lateral approaches with significant morbidity. Nowadays, the endoscopic approach represents a useful alternative. The aim of the present study is to report the results of the endoscopic endonasal approach for drainage of the cyst and using the nasoseptal flap to maintain patent the cavity. Methods A retrospective analysis was carried out on patients with cholesterol granuloma of the petrous apex, endoscopically managed using the nasoseptal flap, at two university centres following a uniform policy. Results Ten patients were treated between June 2008 and Dicember 2013. 6 patients were males, whereas 4 were females. Three patients had been previously treated through an external lateral approach. The lesions where equally distributed between the left and the right side (1:1). All patients underwent an exclusive endoscopic endonasal approach using the nasoseptal flap. In 8 cases the flap was ipsilateral to the lesion while in 2 cases was contralateral. No intraoperative complications were observed. The mean follow-up period was 26 months. Surgery was successful in all cases but one. Conclusion In correctly selected patients, the endoscopic endonasal approach, represents a safe surgical procedure, minimally invasive and with excellent surgical outcomes. The use of the pedicled nasoseptal flap avoids the concentric growth of the granulomatous cyst epithelium, assuring ventilation and drainage of the cystic cavity.