A Case of Temporal Bone Cholesterol Granuloma Extending to Posterior Cranial Fossa without Middle Ear Involvement

Abstract

Cholesterol granulomas of the temporal bone can occur in the petrous apex, middle ear, and mastoid cavity. Although cholesterol granulomas in the petrous apex often extend to the middle cranial fossa, cholesterol granulomas in the middle ear and mastoids rarely invade the cranial cavity with bony erosion. We report a case of a large cholesterol granuloma involving the posterior cranial fossa with pneumatic mastoid and not affecting the middle ear. The patient had no otologic or neurologic symptoms, and the mass was found incidentally on a brain MRI included in a regular medical checkup. The mass was removed via a combined transmastoid and suboccipital approach without complications, and characteristic pathology findings demonstrated a cholesterol granuloma.