Orbitofrontal Cholesterol Granuloma: Four Case Reports and a Systematic Review of the English Literature

Introduction Primary orbitofrontal cholesterol granuloma (OFCG) is rare. We present 4 cases of OFCG and a systematic literature review to examine patient characteristics, presentation, treatment, and outcome. Methodology Our institutional records were reviewed for OFCG cases. A systematic literature review was performed using PubMed. Inclusion criteria were English-language studies with pathology-proven OFCG. Exclusion criteria were OFCG in a craniofacial sinus. The search-string yielded 172 results. Fifty studies met inclusion criteria (39 primary and 11 secondary), and relevant data were reviewed. Results Four patients underwent surgery for OFCG at our institution (ages 53, 43, 34, and 43; 3 females, 1 male). All patients were treated with surgery using a tailored frontal-orbital craniotomy with complete resection. There was no recurrence at 12-month, 4-year, 10-year, and 22-year follow-up for each patient, respectively. Systematic review of the literature identified 172 patients. Follow-up was available in 93 patients (54.1%) with a mean follow-up of 43.3 months. Seven patients demonstrated recurrence at a median of 36 months following surgery. Combining our 4 cases with the 93 patients with reported follow-up gives a recurrence rate of 7% (7/97). Recurrence was associated with incomplete resection and an orbital approach. Conclusion Thorough removal of the lesion with curettage of the boney cavity is recommended for OFCG. Recurrence following complete removal of OFCG is rare.