Characteristics and Clinical Management Strategy of Petrous Apex Cholesterol Granulomas
<b>Purpose:</b> To evaluate the clinical characteristics of petrous apex cholesterol granulomas (PACG) and assess outcomes after different treatment strategies. <b>Method:</b> A consecutive case series of 34 patients with a PACG. Main outcomes were PACG growth, symptoms, and...
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| Format: | Article |
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MDPI AG
2023-02-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/15/4/1313 |
| _version_ | 1797621842102452224 |
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| author | Sanne de Bock Walter Szweryn Thijs Jansen Josje Otten Jef Mulder Jérôme Waterval Yasin Temel Stijn Bekkers Henricus Kunst |
| author_facet | Sanne de Bock Walter Szweryn Thijs Jansen Josje Otten Jef Mulder Jérôme Waterval Yasin Temel Stijn Bekkers Henricus Kunst |
| author_sort | Sanne de Bock |
| collection | DOAJ |
| description | <b>Purpose:</b> To evaluate the clinical characteristics of petrous apex cholesterol granulomas (PACG) and assess outcomes after different treatment strategies. <b>Method:</b> A consecutive case series of 34 patients with a PACG. Main outcomes were PACG growth, symptoms, and the outcomes of different treatment strategies: wait-and-scan (WS) and surgical drainage. <b>Results:</b> Thirty-four patients were analyzed; mean follow-up time was 7.1 years. Twenty-one patients (61.7%) showed symptoms, mostly more than one. Most symptoms reported were cranial nerve palsy (58.8%) and headache (35.3%). Twenty-one patients (61.8%) received solely wait-and-scan (WS), and thirteen patients (38.2%) underwent surgery, five of whom (38.5%) after an initial WS period. In the solely WS group, one (4.8%) developed new symptoms, and two (9.5%) reported symptom progression despite a stable granuloma size. Two (9.5%) showed granuloma growth on follow-up scans without symptom progression. Surgery consisted of drainage. Eleven (84.6%) of these thirteen patients reported partial recovery; one (7.7%) reported no recovery; and one (7.7%) reported full recovery of reported symptoms related to PACG. Among the patients with cranial nerve involvement, 7.7% showed full recovery after surgery; 84.6% showed partial recovery; and 7.7% did not recover. Adverse events occurred in five out of 13 patients who underwent surgery, all with full recovery. <b>Conclusions:</b> This study confirms that PACG are slow-growing lesions with a low risk of adverse events. Solely using wait-and-scan strategy is a safe option for patients without symptoms, with acceptable symptoms without symptom progression, and with asymptomatic growth. Surgical treatment can be considered in patients with symptom progression or symptomatic growth. |
| first_indexed | 2024-03-11T09:01:43Z |
| format | Article |
| id | doaj.art-32aa9fe81b544d8c8db9b798f9b712cd |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-11T09:01:43Z |
| publishDate | 2023-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-32aa9fe81b544d8c8db9b798f9b712cd2023-11-16T19:39:16ZengMDPI AGCancers2072-66942023-02-01154131310.3390/cancers15041313Characteristics and Clinical Management Strategy of Petrous Apex Cholesterol GranulomasSanne de Bock0Walter Szweryn1Thijs Jansen2Josje Otten3Jef Mulder4Jérôme Waterval5Yasin Temel6Stijn Bekkers7Henricus Kunst8Department of Otorhinolaryngology and Head & Neck Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The NetherlandsDepartment of Otorhinolaryngology and Head & Neck Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The NetherlandsDepartment of Otorhinolaryngology and Head & Neck Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The NetherlandsDutch Academic Alliance Skull Base Pathology, Radboud University Medical Center and Maastricht University Medical Center+, 6229 HX Maastricht, The NetherlandsDepartment of Otorhinolaryngology and Head & Neck Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The NetherlandsDutch Academic Alliance Skull Base Pathology, Radboud University Medical Center and Maastricht University Medical Center+, 6229 HX Maastricht, The NetherlandsDutch Academic Alliance Skull Base Pathology, Radboud University Medical Center and Maastricht University Medical Center+, 6229 HX Maastricht, The NetherlandsDepartment of Otorhinolaryngology and Head & Neck Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The NetherlandsDepartment of Otorhinolaryngology and Head & Neck Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands<b>Purpose:</b> To evaluate the clinical characteristics of petrous apex cholesterol granulomas (PACG) and assess outcomes after different treatment strategies. <b>Method:</b> A consecutive case series of 34 patients with a PACG. Main outcomes were PACG growth, symptoms, and the outcomes of different treatment strategies: wait-and-scan (WS) and surgical drainage. <b>Results:</b> Thirty-four patients were analyzed; mean follow-up time was 7.1 years. Twenty-one patients (61.7%) showed symptoms, mostly more than one. Most symptoms reported were cranial nerve palsy (58.8%) and headache (35.3%). Twenty-one patients (61.8%) received solely wait-and-scan (WS), and thirteen patients (38.2%) underwent surgery, five of whom (38.5%) after an initial WS period. In the solely WS group, one (4.8%) developed new symptoms, and two (9.5%) reported symptom progression despite a stable granuloma size. Two (9.5%) showed granuloma growth on follow-up scans without symptom progression. Surgery consisted of drainage. Eleven (84.6%) of these thirteen patients reported partial recovery; one (7.7%) reported no recovery; and one (7.7%) reported full recovery of reported symptoms related to PACG. Among the patients with cranial nerve involvement, 7.7% showed full recovery after surgery; 84.6% showed partial recovery; and 7.7% did not recover. Adverse events occurred in five out of 13 patients who underwent surgery, all with full recovery. <b>Conclusions:</b> This study confirms that PACG are slow-growing lesions with a low risk of adverse events. Solely using wait-and-scan strategy is a safe option for patients without symptoms, with acceptable symptoms without symptom progression, and with asymptomatic growth. Surgical treatment can be considered in patients with symptom progression or symptomatic growth.https://www.mdpi.com/2072-6694/15/4/1313petrous apex cholesterol granulomacharacteristicswait-and-scansurgery |
| spellingShingle | Sanne de Bock Walter Szweryn Thijs Jansen Josje Otten Jef Mulder Jérôme Waterval Yasin Temel Stijn Bekkers Henricus Kunst Characteristics and Clinical Management Strategy of Petrous Apex Cholesterol Granulomas Cancers petrous apex cholesterol granuloma characteristics wait-and-scan surgery |
| title | Characteristics and Clinical Management Strategy of Petrous Apex Cholesterol Granulomas |
| title_full | Characteristics and Clinical Management Strategy of Petrous Apex Cholesterol Granulomas |
| title_fullStr | Characteristics and Clinical Management Strategy of Petrous Apex Cholesterol Granulomas |
| title_full_unstemmed | Characteristics and Clinical Management Strategy of Petrous Apex Cholesterol Granulomas |
| title_short | Characteristics and Clinical Management Strategy of Petrous Apex Cholesterol Granulomas |
| title_sort | characteristics and clinical management strategy of petrous apex cholesterol granulomas |
| topic | petrous apex cholesterol granuloma characteristics wait-and-scan surgery |
| url | https://www.mdpi.com/2072-6694/15/4/1313 |
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