Abstract
Although diagnosis of cholesterol granulomas of the skull base can be straightforward
with computed tomography (CT) and magnetic resonance imaging (MRI) appearance, treatment
is controversial with various skull base approaches described in the literature. This
report describes a 35-year-old man who presented with a symptomatic, enlarging cystic
lesion in the left petrous apex and clivus that had imaging features of a cholesterol
granuloma (cholesterol cyst). Due to a prior history of treated mediastinal germ cell
tumor, pathologic confirmation of the lesion was requested. A CT-guided percutaneous
aspiration revealed dark used motor oil–like fluid. Continued aspiration yielded a
change in the character of the fluid to marrow red. Injection of contrast revealed
no communication with cerebrospinal fluid. Gelfoam (Pfizer, New York, New York, USA)
was subsequently injected percutaneously into the residual cavity. Histopathology
showed no evidence of malignancy and follow-up MRI at 1 month, 3 months, 6 months,
and 1 year demonstrated continued decrease in size and signal of the lesion.
Keywords
cholesterol granuloma - petrous apex - Gelfoam - image guided
