Cholesterol granulomas of the petrous apex. A study of two cases

Cholesterol granuloma of the petrous apex is an inflammatory granulation tissue response to the presence of cholesterol crystals. This lesion is silent for years. The diagnosis is made by the combination of CT and MRI (with and without paramagnetic contrast) that permits accurate differential diagnosis of primary petrous apex lesions. The authors present two patients with cholesterol granulomas of the petrous apex excised completely using a preauricular infratemporal approach. The literature is reviewed and the etiopatogenesis and the histological, clinical, radiographic and therapeutic features of these tumours are discussed. We believe that preauricular infratemporal approach with complete excision of the lesion followed by the obliteration of the cavity with abdominal fat is the procedure of choice when hearing is normal.