case_images: PMC11813199_01
case_images: (A) MRI prior to surgery; (B) CT obtained immediately after surgery for patient 1; (C) Histopathologic image (H&E, x100). Complete removal of the cholesteatoma (red arrow in pane A) of the left temporal bone pyramid and clivus is observed. Typical cholesteatoma is noted in pane C.
case_images: cureus-0017-00000077330-i01.jpg
case_images: PMC11813199_01_cureus-0017-00000077330-i01.jpg
case_images: FIG1
case_images: An MRI study showed a relapse of the epidermoid cyst (Figure 1).
case_images: PMC11813199_02
case_images: (A) MRI prior to surgery; (B) CT obtained immediately after surgery for patient 2; (C) Histopathologic image (H&E, x100). Complete removal of the cholesteatoma (red arrow in pane A) of the left temporal bone pyramid is observed. Typical cholesteatoma is noted in pane C.
case_images: cureus-0017-00000077330-i02.jpg
case_images: PMC11813199_02_cureus-0017-00000077330-i02.jpg
case_images: FIG2
case_images: An MRI of the brain revealed a lesion in the area of the pyramid of the right temporal bone (Figure 2).
case_images: PMC11813199_03
case_images: MRI before surgery (A) and 3.5 years postoperatively (B) for patient 3 ; C: Histopathologic image (H&E, x100). Complete removal of the cholesteatoma of the sphenoid sinus, clivus, and the apices of both temporal bone pyramids (red arrow in pane A) is observed. Typical cholesteatoma is noted in pane C.
case_images: cureus-0017-00000077330-i03.jpg
case_images: PMC11813199_03_cureus-0017-00000077330-i03.jpg
case_images: FIG3
case_images: An MRI of the brain revealed a large lesion of the skull base (Figure 3).
case_images: PMC11813199_04
case_images: (A) MRI prior to surgery; (B) CT obtained immediately after surgery for patient 4; (C) Histopathologic image (H&E, x100). Complete removal of the cholesteatoma (red arrow in pane A) of the left temporal bone pyramid is observed. Typical cholesteatoma is noted in pane C.
case_images: cureus-0017-00000077330-i04.jpg
case_images: PMC11813199_04_cureus-0017-00000077330-i04.jpg
case_images: FIG4
case_images: An MRI of the brain revealed a large lesion in the region of the clivus and the pyramid of the left temporal bone (Figure 4).
case_images: PMC11813199_05
case_images: (A) MRI prior to surgery; (B) CT obtained immediately after surgery for patient 5; (C) Histopathologic image (H&E, x100). Complete removal of the cholesteatoma of the sphenoid sinus, clivus, and the left temporal bone pyramid (red arrow in pane A) is observed. Typical cholesteatoma is noted in pane C.
case_images: cureus-0017-00000077330-i05.jpg
case_images: PMC11813199_05_cureus-0017-00000077330-i05.jpg
case_images: FIG5
case_images: At examination, a large cholesteatoma of the clivus and pyramid of the left temporal bone was detected (Figure 5).
case_images: PMC11813199_06
case_images: CT obtained before surgery (A) and immediately after surgery (B) for patient 6; C: Histopathologic image (H&E, x400). Complete removal of the cholesteatoma of the sphenoid sinus, clivus, and the left temporal bone pyramid  (red arrow in pane A) is observed. Typical cholesteatoma is noted in pane C.
case_images: cureus-0017-00000077330-i06.jpg
case_images: PMC11813199_06_cureus-0017-00000077330-i06.jpg
case_images: FIG6
case_images: An MRI examination demonstrated a lesion destroying the apex of the pyramid of the temporal bone on the left with MR characteristics of a cholesteatoma (Figure 6).
case_images: PMC11813199_07
case_images: (A) MRI; (B) intraoperative photo which shows the pyramid of the temporal bone; (C) CT after surgery for patient 7; D: Histopathologic image (H&E, x100). Large cholesteatoma of the clivus and pyramid of the right temporal bone (red arrow in pane A) removed. In pane B, 1 indicates the internal carotid artery (petrosal segment), and 2 indicates the suction tube. Pane D indicates a typical cholesteatoma.
case_images: cureus-0017-00000077330-i07.jpg
case_images: PMC11813199_07_cureus-0017-00000077330-i07.jpg
case_images: FIG7
case_images: During the examination, an MRI of the brain revealed a large lesion of the clivus and right temporal bone (Figure 7).
case_images: PMC11813199_08
case_images: A) MRI prior to surgery; (B) CT obtained immediately after surgery for patient 8; (C) Histopathologic image (H&E, x100). Complete removal of the cholesteatoma of the sphenoid sinus, clivus, and the left temporal bone pyramid (red arrow in pane A) is observed. Typical cholesteatoma is noted in pane C.
case_images: cureus-0017-00000077330-i08.jpg
case_images: PMC11813199_08_cureus-0017-00000077330-i08.jpg
case_images: FIG8
case_images: The MRI data revealed an apical cholesteatoma of the left temporal bone pyramid extending to the clivus (Figure 8).