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CC BY-NC-ND 4.0 · Asian J Neurosurg
DOI: 10.1055/s-0046-1815954
Case Report

Frontal Cholesterol Granuloma in a Pediatric Patient: A Case Report

Authors

  • Doğu İlerler 

    1   Department of Neurosurgery, Adana City Research and Education Hospital, Adana, Türkiye

  • Saygı Uygur 

    2   Department of Neurosurgery, Kadirli State Hospital, Osmaniye, Türkiye

  • Ali İhsan Ökten 

    1   Department of Neurosurgery, Adana City Research and Education Hospital, Adana, Türkiye
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Abstract

Cholesterol granuloma (CG) is a benign expansile lesion caused by the breakdown of blood products and subsequent granulomatous reaction, most often found in pneumatized bones. Frontal sinus involvement is exceedingly rare, especially in children, and may mimic mucoceles, abscesses, or fungal disease on imaging. We present a 16-year-old male with a painful, progressively enlarging frontal swelling and headache. MRI revealed a lobulated lesion hyperintense on both T1- and T2-weighted sequences with peripheral enhancement, initially suggesting an abscess-like process. CT showed an expansile lytic lesion with erosion of the frontal sinus tables. Due to significant bony destruction, a bicoronal open approach was performed, achieving complete excision and cranioplasty. Histopathology confirmed CG, demonstrating cholesterol clefts, hemosiderin-laden macrophages, and multinucleated giant cells. The postoperative course was uneventful, and no recurrence was observed. This case highlights the diagnostic challenge of frontal sinus CG, particularly in younger patients, and emphasizes the importance of recognizing its radiologic characteristics to avoid misdiagnosis. Early identification and surgical excision are essential to prevent orbital or intracranial complications and achieve favorable clinical outcomes.

Keywords

cholesterol granuloma - frontal sinus - pediatric - paranasal sinus - abscess

Authors' Contributions

D.İ. and A.İ.Ö. contributed to the conception and design of the work. Data acquisition was carried out by D.İ. and S.U., while data analysis was performed by D.İ. and A.İ.Ö. Manuscript preparation was undertaken by D.İ. and S.U., and manuscript editing and review were completed by S.U. and A.İ.Ö.


Ethical Approval

This report was approved by the legal guardians of the patient and was conducted in accordance with the Declaration of Helsinki.




Publication History

Article published online:
06 February 2026

© 2026. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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