2026 Poster Presentations
P049: NEUROSURGICAL MANAGEMENT AND QUALITY OF LIFE IN PATIENTS WITH PETROUS APEX CHOLESTEROL GRANULOMA
Yoojin Choi, MD, PhD; Ryojo Akagami, MD, FRCSC; University of British Columbia
Background: Cholesterol granulomas are rare cysts in the petrous apex surrounded by foreign body giant cells. They can present with a wide range of symptoms including cranial nerve sixth palsy, headache, hearing loss, tinnitus, vertigo and facial nerve palsy. Due to their low prevalence, there is a gap in our understanding of how these patients should be managed. Importantly, no studies have assessed the impact of cholesterol granulomas on the quality of life for patients, which is arguably one of the most crucial measures that can help inform a surgeon’s clinical decision.
Objective: The primary objective of this study is to understand the impact of cholesterol granulomas on the patients’ quality of life.
Methods: This is a retrospective chart review of cholesterol granuloma cases managed by a single surgeon at a quaternary centre in Canada between 2000 and 2025. It is a descriptive study focused on clinical decisions and patient outcomes as measured by symptoms, radiographic evidence and patients’ self-reported data on quality of life. Non-normal data are analyzed using non-parametric tests on SPSS version 31.0.
Results: A total of 14 patients with cholesterol granuloma were identified, of which 6 were treated conservatively and the remaining 8 surgically. The median age of the study population was 43 (range 32-61) with 79% being male. Of those who were symptomatic (8/14), dizziness/balance issues (6/8) and cranial nerve VI palsy (4/8) were the most common presenting symptoms. Others included headache, tinnitus, pain and sensory changes. Interestingly, there were no differences in the baseline self-reported quality of life for patients who were later treated non-operatively versus operatively. However, follow-up surveys demonstrated that patients who were treated operatively had improved quality of life. Of note, all patients reported less bodily pain (p=0.026) and emotional toll (“feeling worn out”; p=0.026) post-operatively, and these in turn enhanced their ability to spend more time on work or physical activities (p=0.020) as well as accomplish tasks previously affected by emotional problems (p=0.046). All surgically managed patients reported resolution of their presenting symptoms caused by cholesterol granuloma.
Conclusions: Surgical management of cholesterol granuloma may have a significant effect on both physical and emotional health, ultimately improving the quality of life for patients.