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Video Abstract

Endoscopic transsphenoidal resection of a recurrent petrous apex cholesterol granuloma: Operative video

Departments of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania,
Department of Neurosurgery, UT Southwestern Medical Center, Dallas, Texas, United States.
Departments of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania,
Corresponding author: James J. Evans, Department of Neurosurgery, Thomas Jefferson University Hospital, 909 Walnut Street, Philadelphia - 19107, Pennsylvania, United States.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Al Saiegh F, Lavergne P, Mahtabfar A, Garzon- Muvdi T, Rosen M, Evans JJ. Endoscopic transsphenoidal resection of a recurrent petrous apex cholesterol granuloma: Operative video. Surg Neurol Int 2020;11:83.



Cholesterol granulomas (GC) of the petrous apex are benign cystic lesions that occur due to a foreign body reaction to blood by-products and cholesterol crystals. They cause erosion and expansion of the petrous apex and lead to cranial nerve deficits.

Case Description:

We present an operative video of a 28-year-old male whose work-up for horizontal diplopia revealed a right petrous apex GC. He originally underwent a subtemporal and later a transmastoid approach at outside institutions before he presented to us with diplopia due to recurrence. An endoscopic transsphenoidal transclival approach was done for drainage and resection of the GC. The patient did well and his diplopia resolved. A follow-up MRI showed no recurrence of the granuloma.


This case illustrates an endoscopic transsphenoidal transclival approach for a recurrent petrous apex CG, which may lead to symptom resolution if done in a timely fashion.


Cholesterol granuloma
Operative video
Transsphenoidal resection


0:10: History & Physical

0:28: Preoperative imaging

0: 53: Elevating the mucoperiosteum

1:09: Removal of sphenoid septations

1:16: Drilling of the clivus

1:32: Opening of the granuloma capsule

1:45: Debridement of cyst contents

2:02: Elevating a nasoseptal flap

2:34: Placement of Rains stent

2:49: Post-operative CT

3:06: Follow-up MRI

[Video 1]-Available on:

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


  1. , , , . Sixth nerve palsy from cholesterol granuloma of the petrous apex. Front Neurol. 2017;8:48. Available from: [Last accessed on 2020 Jan 28]
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