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Contralateral Transmaxillary Approach for a 13-Year-Old Boy with a Petrous Apex Cholesterol Granuloma: A Case Report
Yasuhiro Arai1, Jun Suenaga2, Mitsuru Sato2
1Department of Otolaryngology, Head and Neck Surgery, Yokohama City University, Yokohama, Japan.
Pediatric Neurosurgery
|May 28, 2025
Summary
The endoscopic contralateral transmaxillary (CTM) approach offers a safe and effective solution for petrous apex cholesterol granulomas in children. This minimally invasive technique successfully removed the granuloma without complications, preventing recurrence.
Area of Science:
- Neurosurgery
- Endoscopic Skull Base Surgery
Background:
- Cholesterol granulomas in the petrous apex, particularly those dorsal to the internal carotid artery (ICA), present significant surgical challenges.
- Traditional surgical methods for petrous apex lesions can be invasive and carry risks.
Observation:
- A 13-year-old boy with intractable headache and trigeminal nerve neuralgia was diagnosed with a petrous apex cholesterol granuloma via MRI.
- The granuloma was located dorsal to the petrous portion of the internal carotid artery.
Findings:
- The endoscopic contralateral transmaxillary (CTM) approach was successfully employed for the complete extirpation of the petrous apex cholesterol granuloma.
- Postoperative follow-up, including MRI at 46 months, showed no evidence of granuloma recurrence and resolution of neurological symptoms.
Implications:
- The endoscopic CTM approach is a viable and safe alternative for managing petrous apex cholesterol granulomas, especially in pediatric cases.
- This technique provides a less invasive option for lesions inaccessible via standard transnasal endoscopic approaches.
