Endoscopic transsphenoidal surgery for cholesterol granulomas involving the petrous apex

Surgery for cholesterol granulomas involving the petrous apex has traditionally been performed via a lateral skull base approach. We present a case-series of four cholesterol granulomas treated through the endoscopic-transsphenoid approach over the last 10 years. Drainage was successful and symptomatic improvement was obtained in all cases (follow-up 6 months-10 years). Primary 'sphenoid' lesions, which can be widely drained and remain marsupialised, should be differentiated from primary 'petrous' lesions that can be removed safely through the sphenoid sinus only in case of extension medial to the internal carotid artery (ICA). We feel that the endoscopic transsphenoidal approach is a safe and effective way to access cholesterol granulomas of the petrous apex.