Commentary

The authors have described the case of a cholesteatoma that presented primarily in the clivus. The lesion could possibly have been a “cholesterol granuloma.” A cholesterol granuloma and a cholesteatoma have similar origins in that they occur from obstructed petrous apex air cells, but their appearance on MRI is different. This cystic collection then fills up with cellular debris and cholesterol crystals. It grows by expansion and may erode bone to push the dura. The treatment is complete excision, if possible, by an extradural route. This may be limited if there is extensive dural involvement or if the cholesteatoma is very large. If complete resection is not possible, it may recur. Wide drainage into a sinus cavity is preferred if complete resection is not possible; thus, it is very important to avoid violating the cerebrospinal fluid space.