Cholesterol granuloma of the petrous apex

The traditional approaches to symptomatic cholesterol granuloma (CG), the most common benign pathologic lesion of the petrous apex, have historically been transotic, including middle fossa, translabyrinthine, retrocochlear, or infra- or retrolabyrinthine approaches. These approaches were often fraught with risk to the vestibular or cochlear apparatus, the need for brain retraction, or lack of a natural drainage pathway after marsupialization of the granuloma. This article reviews the literature on the transnasal approach to petrous apex CGs, including medial, medial with carotid medialization, and transpterygoid approaches. Of the 19 reported CGs treated with endoscopic drainage, only one recurrence was noted.