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

BACKGROUND: 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. CONCLUSION: 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.