INTRODUCTION Cholesterol granulomas (CGs) are rare benign cystic lesions containing cholesterol crystals in a gluelike fluid and are frequently found in the petrous apex (PA) and in the nearby anatomical area. The gold standard treatment of PA CG counts on its surgical drainage and ventilation to prevent recurrence. Different surgical approaches have been described in the past to achieve drainage of these lesions, either through lateral, or more recently through an endoscopic endonasal corridor. In this report, we describe an innovative technique used to keep open the site of drainage, using a vascular pedicled nasoseptal flap (Hadad-Bassagasteguy flap) after an endoscopic trans-ethmoid-pterygoid-sphenoidal approach to a petrous apex PACG.
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