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Indications and advantages of endoscopic trans-sphenoid approach for petrous apex lesions: two case reports

Published online by Cambridge University Press:  29 September 2021

S Kajal Open the ORCID record for S Kajal [Opens in a new window] ,
A Thakar  and
H Verma Open the ORCID record for H Verma [Opens in a new window]
S Kajal
Affiliation:
Department of Otorhinolaryngology and Head–Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
A Thakar
Affiliation:
Department of Otorhinolaryngology and Head–Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
H Verma*
Affiliation:
Department of Otorhinolaryngology and Head–Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
*
Author for correspondence: Dr Hitesh Verma, Room 4057, 4th Floor, Academic Block, Department of Otorhinolaryngology and Head–Neck Surgery, All India Institute of Medical Sciences, New Delhi, India E-mail: drhitesh10@gmail.com
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Abstract

Background

The choice of surgical approach for a petrous apex lesion depends on its relationship with the internal carotid artery, degree of medial expansion and pathology. The correct identification of patients who will benefit from this approach is necessary.

Case reports

Two adult patients presented with a lesion in the left petrous apex. Computed tomography showed a homogeneous mass extending anteromedially, and abutting the internal carotid artery and the sphenoid sinus in both patients. Using magnetic resonance imaging, a third recurrence of cholesterol granuloma in case one and cholesteatoma in case two were diagnosed. Both patients underwent trans-sphenoid excision, as the sphenoid sinus was well pneumatised and the lesion was medial to the internal carotid artery.

Conclusion

Nasal endoscopic access to the petrous apex via the trans-sphenoid corridor should be preferred for benign lesions extending anteromedially in cases where lateral access is impeded by the internal carotid artery, the labyrinth and the facial nerve, and anterior trans-sphenoidal access offers a low-morbidity alternative.

Keywords

Petrous ApexCholesterol GranulomaEpidermoid CystCholesteatomaTrans-Sphenoid Approach
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 136 , Issue 10 , October 2022 , pp. 1005 - 1009
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Dr H Verma takes responsibility for the integrity of the content of the paper

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