Cholesterol granulomas of the petrous apex are inflammatory reactions due to obstruction of air cells within the petrous apex. We report two cases of petrous apex cholesterol granulomas that were treated via the endoscopic transsphenoidal route. The transsphenoidal approach is minimally invasive, preserves hearing and drains these cysts into the sphenoid sinus. We consider this approach to be the technique of choice for a cholesterol granuloma that abuts sphenoid sinus.