open access

Vol 50, No 6 (2016)
Case reports
Submitted: 2016-03-02
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Endoscopic transsphenoidal surgery using pedicle vascularized nasoseptal flap for cholesterol granuloma in petrous apex: A technical note

Yukitomo Ishi, Hiroyuki Kobayashi, Hiroaki Motegi, Shogo Endo, Shigeru Yamaguchi, Shunsuke Terasaka, Kiyohiro Houkin
DOI: 10.1016/j.pjnns.2016.08.006
·
Neurol Neurochir Pol 2016;50(6):504-510.

open access

Vol 50, No 6 (2016)
Case reports
Submitted: 2016-03-02

Abstract

Background

Compared with surgical resection, endoscopic transsphenoidal surgery (TSS) for cholesterol granuloma (CG) in the petrous apex (PA) is associated with local recurrence due to obstruction of the drainage route. We present a detailed procedure of an endoscopic TSS using pedicle vascularized nasoseptal flap (PVNF).

Methods

A 40-year-old woman with a history of repeated surgery for left tympanitis was referred to our institution. Neurological examination revealed severe hearing loss in the left ear. Radiologic examination presented a round mass in the left PA and significant fluid collection in the mastoid air cells of the left temporal bone. CG was strongly suspected, and endoscopic TSS using PVNF was performed. Prior to endoscopic drainage, a PVNF was harvested from the mucosa of the ipsilateral nasal septum, with an attempt to preserve the sphenopalatine artery in the flap. Following this, puncture and adequate irrigation of the lesion was performed by endoscopic TSS, with neuro-navigation system assistance; the apex of PVNF was then placed into the lesion to prevent the obstruction of the drainage route. An absorbable polyglycolic acid sheet and fibrin glue were applied on the flap to prevent spontaneous deviation from the lesion.

Results

The patient was discharged without any further neurological complications. Eight-month postoperative computed tomography images showed no recurrence; the drainage route was patent and the fluid collection in the left mastoid air cells was resolved. Moreover, hearing loss was improved.

Conclusions

Endoscopic TSS using PVNF may be one of available surgical options for PACG.

Abstract

Background

Compared with surgical resection, endoscopic transsphenoidal surgery (TSS) for cholesterol granuloma (CG) in the petrous apex (PA) is associated with local recurrence due to obstruction of the drainage route. We present a detailed procedure of an endoscopic TSS using pedicle vascularized nasoseptal flap (PVNF).

Methods

A 40-year-old woman with a history of repeated surgery for left tympanitis was referred to our institution. Neurological examination revealed severe hearing loss in the left ear. Radiologic examination presented a round mass in the left PA and significant fluid collection in the mastoid air cells of the left temporal bone. CG was strongly suspected, and endoscopic TSS using PVNF was performed. Prior to endoscopic drainage, a PVNF was harvested from the mucosa of the ipsilateral nasal septum, with an attempt to preserve the sphenopalatine artery in the flap. Following this, puncture and adequate irrigation of the lesion was performed by endoscopic TSS, with neuro-navigation system assistance; the apex of PVNF was then placed into the lesion to prevent the obstruction of the drainage route. An absorbable polyglycolic acid sheet and fibrin glue were applied on the flap to prevent spontaneous deviation from the lesion.

Results

The patient was discharged without any further neurological complications. Eight-month postoperative computed tomography images showed no recurrence; the drainage route was patent and the fluid collection in the left mastoid air cells was resolved. Moreover, hearing loss was improved.

Conclusions

Endoscopic TSS using PVNF may be one of available surgical options for PACG.

Get Citation

Keywords

CG, CT, MRI, PA, PACG, PVNF, SPA, TSS

About this article
Title

Endoscopic transsphenoidal surgery using pedicle vascularized nasoseptal flap for cholesterol granuloma in petrous apex: A technical note

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 50, No 6 (2016)

Pages

504-510

DOI

10.1016/j.pjnns.2016.08.006

Bibliographic record

Neurol Neurochir Pol 2016;50(6):504-510.

Keywords

CG
CT
MRI
PA
PACG
PVNF
SPA
TSS

Authors

Yukitomo Ishi
Hiroyuki Kobayashi
Hiroaki Motegi
Shogo Endo
Shigeru Yamaguchi
Shunsuke Terasaka
Kiyohiro Houkin

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