CASE REPORT Lobulated Petrous Apex Cholesterol Granuloma Treated with Infracochlear and Transsphenoidal Approaches

404 Petrous apex cholesterol granulomas are relatively rare lesions. They are usually unilocular and treated with simple fenestration. However, lobulated lesions require total removal of debris inside the cysts. Herein, we report a first case with a lobulated petrous apex cholesterol granuloma. The lesion extended from cerebello-pontine angel to the clivus. It was lobulated and contained debris, meaning that total surgical access was necessary to avoid intra-lesional obstruction. Consecutive infracochlear and transsphenoidal approach under image guidance enabled total removal of debris and successful drainage without causing further neurological deficits.