CC BY-NC-ND 4.0 · Laryngorhinootologie 2018; 97(S 02): S235
DOI: 10.1055/s-0038-1640527
Otologie: Otology
Georg Thieme Verlag KG Stuttgart · New York

Transsphenoidal and infralabyrinthine approach in cholesterol granulomas of the petrous apex

J Quandt
1  HNO UKSH Lübeck, Lübeck
KL Bruchhage
1  HNO UKSH Lübeck, Lübeck
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18. April 2018 (online)



Cholesterol granulomas are among the most common benign tumors of the petrous apex and often present with uncharacteristics symptoms. The exposed position presents the ENT surgeon with a number of intraoperative problems, so the choice of the appropriate access route is of particular importance.


In the retrospective analysis of cholesterol granulomas of the petrous apex, nine patients were compared with regard to their surgical approach (transsphenoidal vs. infralabyrinthine) and their postoperative symptoms.


In 3 cases where the transsphenoidal approach was chosen, all patients were symptom-free, with the postoperative function of the inner ear as well as of the balance remaining unrestricted. No complaints were also achieved in the 6 patients who underwent surgery via the infralabyrinthine approach. With preserved inner ear function, the treatment of conductive hearing loss with the Vibrant Sound bridge took place in 3 cases, 2 patients received conventional hearing aids and one patient was treated by a TORP.


Both the anatomy of the petrous apex and its pathology should determine the operative approach of the surgeon. In our opinion the navigated transsphenoidal and infralabyrinthine approach both represent a safe alternative.