Huge Cholesterol Granuloma Cysts: A Treatment Rationale

• Main Authors: Chang, Ki-Hong, Park, Kyung-Ho, Song, Chang-Eun, Yeo, Sang-Won
• Format: Conference Proceeding
• Language: English
• ISSN: 1531-5010; 1532-0065
• DOI: 10.1055/s-2007-984280

Purpose: To elucidate the principle of management for a huge cholesterol granuloma (CG) cyst that extends into the posterior cranial fossa or upper neck. Methods: The authors experienced and treated a 53-year-old female patient with a huge cholesterol granuloma cyst extending from the mastoid process to the posterior cranial fossa and the neck, and a 29-year-old male patient with a huge cholesterol granuloma cyst arising from the mastoid process and extending intracranially to the posterior cranial fossa close to the midline. Results: Excision and drainage were performed through the transmastoid approach. The surgical defect was obliterated by utilizing a rotational temporal muscle myofascial flap after complete removal of the cyst wall when it extended into the posterior cranial fossa and the neck. In another case extending into the posterior cranial fossa close to the midline, the obliteration procedure was not carried out and natural gravitational drainage through the Eustachian tube could be secured. Conclusion: Small CG are frequently encountered in the mastoid air cell system during chronic ear surgery. But they rarely appear in a size over several centimeters, and even more rarely extend to involve the intracranial structures or the neck as happened in our cases. The management principle of CG is to secure a permanent drainage regardless of size or location. We think it is proper to completely remove the cyst with epithelium lining and obliterate the defect when gravity-dependent drainage is impossible. If permanent drainage can be achieved after removal of the cyst with or without epithelium lining, no further manipulation such as obliteration procedure is necessary.