Fig. 3.

A 35-year-old man with prior medical history of treated mediastinal germ cell tumor who presented with several weeks of gradually increasing pain along the left side of the head and trapezius as well as difficulty with speech and swallowing. (A) Axial T1-weighted image from the preprocedural magnetic resonance imaging demonstrates an expansile T1 hyperintense lesion in the left petrous apex (see arrow) that was noted to be enlarging from prior studies. The patient was referred for biopsy to exclude metastatic disease given a prior history of malignancy. (B) Axial intraprocedural computed tomography demonstrates a 22-gauge needle with its tip within the lesion (see arrow). Aspiration yielded dark motor oil–like fluid that later turned a lighter, more serosanguineous color. Subsequently, Gelfoam slurry was injected into the aspirated cavity and the needle was removed. (C) Axial T1-weighted image from a follow-up MRI 23 months status postaspiration and Gelfoam embolization demonstrates complete resolution of T1 hyperintense signal within the lesion (see arrow). The patient had complete resolution of symptoms on clinical follow-up. (Reprinted with permission from Lee TC, Raghavan D, Curtin HD. Image-guided percutaneous aspiration and Gelfoam treatment of petrous apex cholesterol granuloma: a new theory and method for diagnosis and treatment. J Neurol Surg B Skull Base 2013;74:342–346.)