Cholesterol granulomas are often diagnosed as an incidental finding, in which case they will often require no treatment other than surveillance. If, however, your cholesterol granuloma is creating a pressure effect on surrounding structures and thereby producing symptoms, it is likely it will require surgical intervention.
The aim of surgery in cholesterol granulomas is to re-aerate the airspace that has become occluded. This, therefore, means re-establishing some sort of connection between the cholesterol granuloma and one of the naturally occurring air spaces in the base of your skull such as air sinuses or the mastoid air cells. Depending upon the exact location of the granuloma, an appropriate surgical approach will then be recommended.
On occasion, this can be done using endoscopes through the nasal cavity and air sinuses to break into the cholesterol granuloma through this route. Once communication has been established, it can be maintained by placement of a small plastic tube to ensure that the cholesterol granuloma does not recur.
Alternatively, this might be done through the bone of the middle ear through an operation carried out just behind the ear. Again, once communication is established, it is often maintained by leaving a small drainage tube internally. Once your cholesterol granuloma has been treated, it will still be followed up with further scans to ensure that it does not re-accumulate. Very occasionally, further surgery can then be required.