[Cholesterol granuloma of the petrous apex]

Cholesterol granuloma of the petrous apex is a relatively rare tumor, and usually is not associated with middle ear pathology. Precise assessment of the diagnosis and extension allows the surgeon to plan the most appropriate and functional strategy. The advent of magnetic resonance imaging has helped, showing a high signal in T1 and T2 without enhancement after the administration of intravenous paramagnetic contrast. The occipito-temporal approach provides direct access to the anterior and posterior petrous apex without opening the dura, which preserves the facial and the cochlear-vestibular functions.