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Cholesterol granuloma of the petrous apex. Case report.

The patient was a 57-year-old woman who, 2 years prior to admission, had 2 to 3 days of transient episodes of tinnitus in the right ear associated with a gait that veered to the right. The symptoms recurred 1 year and again 3 months before admission, but this time they were accompanied by intermittent right hemifacial spasm, diplopia on right lateral gaze, right ocular pain, and intermittent "shooting" pains in the right forehead. The patient was admitted to another hospital where the following evaluation was made. Skull films with laminograms revealed erosion of the right petrous apex and a soft tissue mass in the sphenoid sinus. Angiography demonstrated that the right carotid artery was circumferentially compressed at the foramen lacerum, and that the right posterior cerebral and superior cerebellar arteries were slightly elevated. She was placed on Decadron. A transnasal biopsy of the sphenoid sinus was undertaken, which showed only normal sinus mucosa; following this, the pain diminished dramatically. The patient's serum cholesterol was noted to have changed from 276 mg% in 1971 to 370 mg% at the time of the biopsy 2 years later. Examination. On admission to the University of Washington Hospital, neurological examination revealed only a right sixth nerve paresis. Complete blood count, electrolytes, blood urea nitrogen, and VDRL were normal. A pneumoencephalogram combined with upright polytomography showed a mass extending from the petrous apex posteriorly and surrounded by an extremely thin rim of calcium