Giant septated petrous apex cholesterol granuloma

Abstract Cholesterol granulomas are benign, cystic lesions of the temporal bone that can cause neurological symptoms when sufficiently large. Though often unilocular, complicated cholesterol granulomas with septated compartments pose additional challenges for surgical drainage. We present an unusual case of a recurrent, symptomatic giant left petrous apex cholesterol granuloma partitioned by the intrapetrous carotid artery. Posterior and anterior compartments were drained separately using contemporaneous translabyrinthine and transsphenoidal approaches to minimize treatment morbidity and maximize treatment benefit.