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Yang B, Zhang F, Xu S, Jiang X. Petrous bone cholesteatoma presenting as CSF rhinorrhea: An extremely rare case report. EAR, NOSE & THROAT JOURNAL 2022:1455613221075219. [PMID: 35125011 DOI: 10.1177/01455613221075219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Patients with petrous bone cholesteatoma most commonly present with hearing loss and facial paralysis. Other clinical presentations can include otorrhea, tinnitus, aural fullness, otalgia, and dizziness. Here, we report a patient with petrous bone cholesteatoma who presented with cerebrospinal fluid rhinorrhea. This patient was initially misdiagnosed with rhinogenic cerebrospinal fluid leakage, and was finally diagnosed with the supralabyrinthine type of petrous bone cholesteatoma. During the surgical repair through the transmastoid trans-superior semicircular canal approach, the fistula was found in the superior wall of the internal auditory canal. He had satisfactory outcomes after the surgery, with no recurrent cerebrospinal fluid rhinorrhea.
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Affiliation(s)
- Bo Yang
- Department of Otolaryngology Head and Neck Surgery, 159407The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Fang Zhang
- Department of Otolaryngology Head and Neck Surgery, 462540The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Shan Xu
- Department of Otolaryngology Head and Neck Surgery, 159407The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xuejun Jiang
- Department of Otolaryngology Head and Neck Surgery, 159407The First Affiliated Hospital of China Medical University, Shenyang, China
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Anikin IA, Lilenko SV, Khamgushkeeva NN. [Clinical case for removal supralabyrinthine petrous bone cholesteatoma with improvement of hearing function]. Vestn Otorinolaringol 2022; 87:57-61. [PMID: 35605273 DOI: 10.17116/otorino20228702157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The article presents the clinical case of supralabyrinthine petrous bone cholesteatoma. We have analyzed the preoperative examination of the patient for identification method of surgical treatment with preservation the facial nerve, improvement hearing function and reducing risk of recurrent cholesteatoma, perioperative findings and the end result of surgical treatment.
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Affiliation(s)
- I A Anikin
- St. Petersburg Research Institute of Ear, Throat, Nose and Speech, St. Petersburg, Russia
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - S V Lilenko
- St. Petersburg Research Institute of Ear, Throat, Nose and Speech, St. Petersburg, Russia
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - N N Khamgushkeeva
- St. Petersburg Research Institute of Ear, Throat, Nose and Speech, St. Petersburg, Russia
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Kryukov AI, Garov EV, Zelikovich EI, Zelenkova VN, Zelenkov AV, Pryakhina MA. [Diagnosis and surgical outcomes in the management of petrous bone cholesteatoma]. Vestn Otorinolaringol 2022; 87:9-18. [PMID: 36107174 DOI: 10.17116/otorino2022870419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of surgical treatment of patients with petrous bone cholesteatoma (PBC) depending on the localization of the pathological process. MATERIAL AND METHODS The analysis of surgical treatment using various surgical approaches and its results in 32 patients with PBC, depending on the type, localization in petrous bone and intraoperative findings, is presented. Patients with supralabirint PBC underwent extended atticoantromastoidotomy with tympanoplasty and mastoidoplasty with automaterials (n=19), labyrinthectomy (n=4), subtotal petrozectomy with labyrinthectomy and suturing of the external auditory meatus (EAM) (n=2). In infralabirint and infralabirint-apical PBC, a transotic approach was used with Rambo suturing of EAM (n=9). The pre-sigmoid approach was performed in 1 patient. With an extradural subtemporal approach, PBC of apical localization was removed in 1 case. RESULTS After surgical treatment, hearing remained at the same level in 15 (47%) patients, 14 of them had deafness. In the early postoperative period, a temporary increase in bone conduction hearing thresholds by 10-20 dB was detected in 14 (44%) patients with their gradual recovery over 3 months. Deafness in the postoperative period developed in 3 (9%) patients after removal of supralabirint cholesteatoma. In the early postoperative period, 3 (9%) patients developed systemic dizziness, which was stopped after 3 months. In 25 (78%) patients, the function of the facial nerve in the early postoperative period remained at the same level, of which 14 (44%) were normal, and 11 (34%) had the same degree according to the House-Brackmann (HB) classification. Improvement of function by one degree of HB classification was observed in 4 (12.5%) patients on average 5 months after surgery. CONCLUSION An adequate personalized choice of surgical treatment methods allowed mainly to preserve the function of hearing and facial nerve. In cases of deterioration of facial nerve function in the postoperative period, gradual improvement was observed for 3-10.5 months with further positive dynamics.
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Affiliation(s)
- A I Kryukov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - E V Garov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - E I Zelikovich
- Russian Medical Academy for Continuous Professional Education, Moscow, Russia
| | - V N Zelenkova
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - A V Zelenkov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - M A Pryakhina
- Pirogov Russian National Research Medical University, Moscow, Russia
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Petrous bone lesions: surgical implementation and outcomes of extradural subtemporal approach. Acta Neurochir (Wien) 2021; 163:2881-2894. [PMID: 34420107 DOI: 10.1007/s00701-021-04962-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/31/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Petrous bone lesions (PBLs) are rare with few reports in the neurosurgical literature. In this study, the authors describe our current technique of extradural subtemporal approach (ESTA). The objective of this study was to evaluate the role and efficacy of ESTA for treatment of the PBLs. To our knowledge, this is the largest reported clinical series of using an ESTA-treated PBLs in which the clinical outcomes were evaluated. METHODS Between 1994 and 2019, 67 patients with PBLs treated by ESTA were retrospectively reviewed. Extent of resection, neurological outcomes, recurrence rate, and surgical complications were evaluated and compared with previous studies. The indications, advantages, limitations, and outcomes of ESTA were analyzed according to pathology. RESULTS This series included 7 facial nerve schwannomas (10.4%), 16 cholesterol granulomas (23.9%), 16 chordomas (23.9%), 6 chondrosarcomas (9%), 5 trigeminal schwannomas (7.5%), 9 epidermoids/dermoids (13.4%), and 8 other pathologies (11.9%). The most common location of PBLs operated with ESTA was at the petrous apex and rhomboid areas (68.7%). Gross total resection was achieved in 35 (55.6%). Symptomatic improvement occurred in 56 patients (83.6%). Complications occurred in 7 (10.4%) of cases including one mortality. Nine patients (17%) had recurrence within the mean follow-up 71 months. Compared to previous literature, our results demonstrated comparable outcomes but with higher rates of hearing and facial nerve preservation as well as minimal morbidity. From our results, ESTA is an effective therapeutic option for lesions located at the rhomboid and petrous apex, particularly when patients presented with intact facial and hearing function. CONCLUSION Our series demonstrated that ESTA provided satisfactory outcomes with excellent benefits of hearing and facial function preservation for patients with petrous bone lesions. ESTA should be considered as a safe and effective therapeutic option for selected patients with PBLs.
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Bawornvaraporn U, Zomorodi AR, Friedman AH, Fukushima T. Neurosurgical management of petrous bone lesions: classification system and selection of surgical approaches. Acta Neurochir (Wien) 2021; 163:2895-2907. [PMID: 34313854 DOI: 10.1007/s00701-021-04934-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/29/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Surgery of petrous bone lesions (PBLs) is challenging for neurosurgeons. Selection of the surgical approach is an important key for success. In this study, the authors present an anatomical classification for PBLs that has been used by our group for over the past 26 years. The objective of this study is to investigate the benefits and applicability of this classification. METHODS Between 1994 and 2019, 117 patients treated for PBLs were retrospectively reviewed. Using the V3 and arcuate eminence as reference points, the petrous bone is segmented into 3 parts: petrous apex, rhomboid, and posterior. The pathological diagnoses, selection of the operative approach, and the extent of resection (EOR) were analyzed and correlated using this classification. RESULTS This series included 22 facial nerve schwannomas (18.8%), 22 cholesterol granulomas (18.8%), 39 chordomas/chondrosarcomas (33.3%), 6 trigeminal schwannomas (5.1%), 13 epidermoids/dermoids (11.1%), and 15 other pathologies (12.8%). PBLs were most often involved with the petrous apex and rhomboid areas (46.2%). The extradural subtemporal approach (ESTA) was most frequently used (57.3%). Gross total resection was achieved in 58.4%. Symptomatic improvement occurred in 92 patients (78.6%). Our results demonstrated a correlation between this classification with each type of pathology (p < .001), selection of surgical approaches (p < 0.001), and EOR (p = 0.008). Chordoma/chondrosarcoma, redo operations, and lesions located medially were less likely to have total resection. Temporary complications occurred in 8 cases (6.8%), persistent morbidity in 5 cases (4.3%), and mortality in 1 case. CONCLUSION In this study, we proposed a simple classification of PBLs. Using landmarks on the superior petrosal surface, the petrous bone is divided into 3 parts, apex, rhomboid, and posterior. Our results demonstrated that chordoma/chondrosarcoma, redo operations, and lesions involving the tip of the petrous apex or far medial locations were more difficult to achieve total resection. This classification could help surgeons understand surgical anatomy framework, predict possible structures at risk, and select the most appropriate approach for each patient.
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Affiliation(s)
- Udom Bawornvaraporn
- Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand.
| | - Ali R Zomorodi
- Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Allan H Friedman
- Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Takanori Fukushima
- Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA
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Liu Y, Wang F, Shen W, Liu J, Zhao H, Han W, Chen L, Yuan H, Dai P, Han D, Yang S, Hou Z. Petrous bone cholesteatoma: our experience of 20 years and management of two giant cases affecting rhinopharynx. Eur Arch Otorhinolaryngol 2021; 279:2791-2801. [PMID: 34255147 DOI: 10.1007/s00405-021-06969-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To demonstrate our experience in the treatment of petrous bone cholesteatoma (PBC). METHODS Data of PBC patients in our hospital from January 2000 to December 2019 were collected. Surgical approaches and facial function were mainly discussed and compared with the literature. The management of 2 giant PBC cases affecting rhinopharynx has been demonstrated. RESULTS The supralabyrinthine type was the most frequent type followed by the massive type. There were 5 cases with cholesteatoma extending into the clivus (2 cases), sphenoid (1 case) and rhinopharynx (2 cases). The translabyrinthine approach (40%) was our most frequently used approach followed by the middle fossa approach (36%) and the transmastoid approach (11%). There were 10 cases managed with the assistance of endoscope, including 3 cases with cholesteatoma extending into clivus, sphenoid and rhinopharynx separately. Obliteration of the cavity was performed in 70.3% (135/192) cases; 3 of them recurred. For the 2 giant PBC cases affecting rhinopharynx, traditional microscopic surgery assisted with transnasal endoscope was performed. The reduced exposure was beneficial for postoperative recovery, and the approach in the nasal cavity provided a permanent drainage for postoperative examination. CONCLUSION Otologic endoscope combined with traditional microscopic surgery could reduce the exposure in surgery. For extremely extended cases of PBC, supplementary transnasal endoscopic approach deserves to be considered for the traditional temporal bone approach.
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Affiliation(s)
- Ya Liu
- Department of Otolaryngology Head and Neck Surgery, 6th Medical Center, PLA General Hospital, Beijing, 100048, China.,College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Otolaryngologic Diseases, Beijing, China.,Key Lab of Hearing Science, Ministry of Education, Beijing, China
| | - Fangyuan Wang
- Department of Otolaryngology Head and Neck Surgery, 6th Medical Center, PLA General Hospital, Beijing, 100048, China.,College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Otolaryngologic Diseases, Beijing, China.,Key Lab of Hearing Science, Ministry of Education, Beijing, China
| | - Weidong Shen
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Otolaryngologic Diseases, Beijing, China.,Key Lab of Hearing Science, Ministry of Education, Beijing, China
| | - Jun Liu
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Otolaryngologic Diseases, Beijing, China.,Key Lab of Hearing Science, Ministry of Education, Beijing, China
| | - Hui Zhao
- Department of Otolaryngology Head and Neck Surgery, 6th Medical Center, PLA General Hospital, Beijing, 100048, China.,College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Otolaryngologic Diseases, Beijing, China.,Key Lab of Hearing Science, Ministry of Education, Beijing, China
| | - Weiju Han
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Otolaryngologic Diseases, Beijing, China.,Key Lab of Hearing Science, Ministry of Education, Beijing, China
| | - Lei Chen
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Otolaryngologic Diseases, Beijing, China.,Key Lab of Hearing Science, Ministry of Education, Beijing, China
| | - Hu Yuan
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Otolaryngologic Diseases, Beijing, China.,Key Lab of Hearing Science, Ministry of Education, Beijing, China
| | - Pu Dai
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Otolaryngologic Diseases, Beijing, China.,Key Lab of Hearing Science, Ministry of Education, Beijing, China
| | - Dongyi Han
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Otolaryngologic Diseases, Beijing, China.,Key Lab of Hearing Science, Ministry of Education, Beijing, China
| | - Shiming Yang
- Department of Otolaryngology Head and Neck Surgery, 6th Medical Center, PLA General Hospital, Beijing, 100048, China.,College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Otolaryngologic Diseases, Beijing, China.,Key Lab of Hearing Science, Ministry of Education, Beijing, China
| | - Zhaohui Hou
- Department of Otolaryngology Head and Neck Surgery, 6th Medical Center, PLA General Hospital, Beijing, 100048, China. .,College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China. .,National Clinical Research Center for Otolaryngologic Diseases, Beijing, China. .,Key Lab of Hearing Science, Ministry of Education, Beijing, China.
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Management of Intractable Petrous Bone Cholesteatoma With a Combined Translabyrinthine-Transsphenoidal Approach. Otol Neurotol 2021; 42:e311-e316. [PMID: 33555753 DOI: 10.1097/mao.0000000000002952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate whether a combined translabyrinthine-transsphenoidal approach can be used to achieve adequate surgical resection of an extensive petrous bone cholesteatoma and create a debris drainage route for the residual cholesteatoma that is maintained long-term. PATIENT A 71-year-old man with residual petrous temporal bone cholesteatoma that had spread extensively to the internal carotid artery and posterior cranial fossa. INTERVENTION Surgical resection of the cholesteatoma via a translabyrinthine approach and creation of a debris drainage route into the nasopharynx via a transsphenoidal approach. MAIN OUTCOME MEASURES Control of unresectable petrous temporal bone cholesteatoma and occurrence of cholesteatoma- or surgery-related complications. RESULTS Although complete removal of the cholesteatoma was attempted via a translabyrinthine approach, this was not possible because the epithelium of the cholesteatoma was strongly attached to the internal carotid artery and posterior cranial fossa. A debris drainage route leading to the nasopharynx was created by drilling the clivus on the side of the lesion via a transsphenoidal approach. The patient has had no complications since surgery. The drainage route remains open, and the cholesteatoma has been controlled for 57 months. CONCLUSIONS A markedly advanced petrous temporal bone cholesteatoma can be managed safety and reliably by combining a translabyrinthine approach with a transsphenoidal approach. Creation of a debris drainage route into the nasopharynx can prevent isolation of the cholesteatoma and mastoid cavity problems after surgery. This one-stage surgery may be a suitable method for keeping cholesteatoma under control in patients with unresectable petrous bone cholesteatoma.
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Gao Z, Tang WL, Qin ZJ, Zhao WD, Dai CF, Chi FL, Yuan YS. Modified Translabyrinthine Approach for Massive Petrous Bone Cholesteatoma Removal and Cochlear Preservation Using Latent Spaces Anterior to the Cochlea. World Neurosurg 2020; 143:84-90. [PMID: 32730964 DOI: 10.1016/j.wneu.2020.07.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/19/2020] [Accepted: 07/21/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Microsurgery is the reference standard treatment of petrous bone cholesteatoma (PBC). In most cases, radical removal of an extensive PBC can only be achieved at the cost of sacrificing the cochlea. Such treatment will result in the impossibility of future cochlear implantation for hearing rehabilitation purposes. To address this issue, a modification of the traditional translabyrinthine (TL) approach with endoscopic assistance has been developed for radical removal of extensive PBC with preservation of the cochlea. METHODS From June 2017 to December 2017, 3 patients with a massive PBC underwent surgical removal using the modified TL approach by the senior author in our department. We reviewed the patient characteristics and retrospectively studied the surgical outcomes and postoperative complications. In the present report, we have described our modified TL approach in detail. RESULTS Complete resection of the PBC and successful cochlea preservation were achieved in all 3 patients. No recurrence had developed during the follow-up period. However, various degrees of cochlear ossification were observed in 2 patients postoperatively. CONCLUSIONS This modified TL approach provides the possibility of fully exposing the whole petrous apex without removing the cochlea in selected cases. However, the development of long-term cochlear ossification requires further investigation to allow for successful cochlear implantation.
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Affiliation(s)
- Zhen Gao
- Department of Otology and Skull Base Surgery, Eye and ENT Hospital, Fudan University, Shanghai, People's Republic of China; NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, People's Republic of China
| | - Wen-Long Tang
- Department of Neurosurgery, Peace Hospital of Changzhi Medical College, Changzhi, People's Republic of China
| | - Zhao-Jun Qin
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Wei-Dong Zhao
- Department of Otology and Skull Base Surgery, Eye and ENT Hospital, Fudan University, Shanghai, People's Republic of China; NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, People's Republic of China
| | - Chun-Fu Dai
- Department of Otology and Skull Base Surgery, Eye and ENT Hospital, Fudan University, Shanghai, People's Republic of China; NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, People's Republic of China
| | - Fang-Lu Chi
- Department of Otology and Skull Base Surgery, Eye and ENT Hospital, Fudan University, Shanghai, People's Republic of China; NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, People's Republic of China
| | - Ya-Sheng Yuan
- Department of Otology and Skull Base Surgery, Eye and ENT Hospital, Fudan University, Shanghai, People's Republic of China; NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, People's Republic of China.
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Patient-specific 3D-printed Model-assisted Supracochlear Approach to the Petrous Apex. Otol Neurotol 2020; 41:e1041-e1045. [PMID: 32472919 DOI: 10.1097/mao.0000000000002720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To present a case of pediatric cholesteatoma that invaded the petrous apex (PA) and discuss the usefulness of preoperative three-dimensional (3D) surgical simulation on a personal computer (PC) and patient-specific 3D printed model-assisted surgery. PATIENT A 5-year-old boy with congenital cholesteatoma underwent a planned two-stage canal wall up mastoidectomy. The cholesteatoma had invaded the PA from a small space anterior to the superior semicircular canal (SSCC). During the removal of this lesion in the first surgery, the tip of a 1-mm round knife broke off and fell into the PA. The surgeon could not remove it, as it was thought that opening the space might damage the SSCC and the facial nerve (FN). INTERVENTION Before the second surgery, a preoperative 3D surgical simulation on a PC was performed, and an approach to the PA via the triangle surrounded by the SSCC, FN, and middle cranial fossa, namely, the supracochlear approach, was discovered. A patient-specific 3D-printed model, which had been drilled to make each surface of the triangle including the SSCC, FN, and middle cranial fossa visible in the PC simulation surgery, was then created and a 3D-printed model-assisted surgery was planned. RESULTS By placing the sterilized patient-specific 3D model close to the surgical field, the cholesteatoma and iatrogenic foreign body could be successfully removed from the PA without damaging the important surrounding structures. CONCLUSIONS Preoperative 3D surgical simulations and intraoperative patient-specific 3D-printed model-assisted surgeries are new, powerful tools that aid in performing challenging surgeries on temporal bones.
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Al Zaabi K, Hassannia F, Bergin MJ, Rutka JA. Management of invasive intralabyrinthine cholesteatoma: Can one realistically preserve hearing when disease is medial to the otic capsule? Am J Otolaryngol 2020; 41:102407. [PMID: 32014300 DOI: 10.1016/j.amjoto.2020.102407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/21/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE To report our long-term results in surgical management of invasive intralabyrinthine cholesteatoma. MATERIAL AND METHODS The study is a case series in a tertiary referral center. Retrospective chart review of all mastoid operations performed for chronic ear disease between 1994 and 2019 at University Health Network, Toronto. The type of surgery, intraoperative findings, hearing outcome, recurrence of disease and the need for revision surgery were evaluated. RESULTS 10 cases of extensive petrous bone cholesteatoma medial to the otic capsule were identified in 616 mastoid surgeries. All but one patient with extensive petrous bone cholesteatoma who underwent an exteriorizing procedure to preserve cochlear function failed the first surgery. A second procedure was needed in all cases due to complications which included facial palsy, recurrent cholesteatoma or internal auditory canal (IAC) abscess. Hearing was not preserved in any patient. In contrast, 57 ears with cholesteatomatous labyrinthine fistula lateral to the otic capsule had matrix exteriorized and had very good long-term results. CONCLUSION We were rarely able to preserve hearing in massive petrous bone cholesteatoma. There should be no hesitation to remove the otic capsule to exteriorize diseases even under circumstances where residual cochlear and vestibular function is present if required to provide a safe ear.
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Anikin IA, Khamgushkeeva NN, Astashchenko SV, Bokuchava TA. [Clinical case for removal infralabyrinthine petrous bone cholesteatoma with preservation the facial nerve]. Vestn Otorinolaringol 2019; 84:56-60. [PMID: 31486429 DOI: 10.17116/otorino20198403156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The article presents the case report of infralabyrinthine petrous bone cholesteatoma. We have analyzed the preoperative examination of the patient for identification method of surgical treatment with preservation the facial nerve and reducing cholesteatoma risk, perioperative findings and the end result of surgical treatment.
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Affiliation(s)
- I A Anikin
- St.-Petersburg Research Institute of Ear, Throat, Nose and Speech, St.-Petersburg, Russia, 190013
| | - N N Khamgushkeeva
- St.-Petersburg Research Institute of Ear, Throat, Nose and Speech, St.-Petersburg, Russia, 190013
| | - S V Astashchenko
- St.-Petersburg Research Institute of Ear, Throat, Nose and Speech, St.-Petersburg, Russia, 190013
| | - T A Bokuchava
- Murmansk Regional Clinical Hospital named P.A. Bayandin, Murmansk, Russia, 183035
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Petrous bone cholesteatoma: our experience of 51 patients with emphasis on cochlea preservation and use of endoscope. Acta Otolaryngol 2019; 139:576-580. [PMID: 31050582 DOI: 10.1080/00016489.2019.1605455] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Petrous bone cholesteatoma (PBC) is a rare but local aggressive lesion which can lead to severe complications. Surgery is the mainstay for its treatment. Objectives: To analyse the clinical characteristics and surgical outcomes in a series of patients with PBC, paying special attention to cochlea preservation and use of endoscope. Materials and methods: Retrospective study of 51 patients with PBC who underwent surgery at our centre. Results: Hearing loss (72.5%) and facial paralysis (58.8%) were the two most common symptoms. According to Sanna's classification, supralabyrinthine subtype (51.0%) was the most common subtype, followed by the massive subtype (33.3%). In most patients, PBC was radically removed using subtotal petrosectomy (80.4%). Endoscope was used for assistance in six cases. Various managements of facial nerve were used in different cases. Hearing rehabilitation was not emphasized (44 postoperative dead ear); however, cochlea was preserved as far as possible (45.3%). Recurrence was identified in five patients by MRI with diffusion weighted imaging (DWI) sequence. No recurrence was detected in patients underwent surgery with endoscope assistance. Conclusions and significance: radical excision and functional reconstruction constitute the framework of PBC surgery. Cochlea preservation is critical for possible cochlear implantation in the future. Use of endoscope has the potential to enhance surgical precision and reduce recurrence.
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Zanoletti E, Mazzoni A, Martini A, Abbritti RV, Albertini R, Alexandre E, Baro V, Bartolini S, Bernardeschi D, Bivona R, Bonali M, Borghesi I, Borsetto D, Bovo R, Breun M, Calbucci F, Carlson ML, Caruso A, Cayé-Thomasen P, Cazzador D, Champagne PO, Colangeli R, Conte G, D'Avella D, Danesi G, Deantonio L, Denaro L, Di Berardino F, Draghi R, Ebner FH, Favaretto N, Ferri G, Fioravanti A, Froelich S, Giannuzzi A, Girasoli L, Grossardt BR, Guidi M, Hagen R, Hanakita S, Hardy DG, Iglesias VC, Jefferies S, Jia H, Kalamarides M, Kanaan IN, Krengli M, Landi A, Lauda L, Lepera D, Lieber S, Lloyd SLK, Lovato A, Maccarrone F, Macfarlane R, Magnan J, Magnoni L, Marchioni D, Marinelli JP, Marioni G, Mastronardi V, Matthies C, Moffat DA, Munari S, Nardone M, Pareschi R, Pavone C, Piccirillo E, Piras G, Presutti L, Restivo G, Reznitsky M, Roca E, Russo A, Sanna M, Sartori L, Scheich M, Shehata-Dieler W, Soloperto D, Sorrentino F, Sterkers O, Taibah A, Tatagiba M, Tealdo G, Vlad D, Wu H, Zanetti D. Surgery of the lateral skull base: a 50-year endeavour. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2019; 39:S1-S146. [PMID: 31130732 PMCID: PMC6540636 DOI: 10.14639/0392-100x-suppl.1-39-2019] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Disregarding the widely used division of skull base into anterior and lateral, since the skull base should be conceived as a single anatomic structure, it was to our convenience to group all those approaches that run from the antero-lateral, pure lateral and postero-lateral side of the skull base as “Surgery of the lateral skull base”. “50 years of endeavour” points to the great effort which has been made over the last decades, when more and more difficult surgeries were performed by reducing morbidity. The principle of lateral skull base surgery, “remove skull base bone to approach the base itself and the adjacent sites of the endo-esocranium”, was then combined with function preservation and with tailoring surgery to the pathology. The concept that histology dictates the extent of resection, balancing the intrinsic morbidity of each approach was the object of the first section of the present report. The main surgical approaches were described in the second section and were conceived not as a step-by-step description of technique, but as the highlighthening of the surgical principles. The third section was centered on open issues related to the tumor and its treatment. The topic of vestibular schwannoma was investigated with the current debate on observation, hearing preservation surgery, hearing rehabilitation, radiotherapy and the recent efforts to detect biological markers able to predict tumor growth. Jugular foramen paragangliomas were treated in the frame of radical or partial surgery, radiotherapy, partial “tailored” surgery and observation. Surgery on meningioma was debated from the point of view of the neurosurgeon and of the otologist. Endolymphatic sac tumors and malignant tumors of the external auditory canal were also treated, as well as chordomas, chondrosarcomas and petrous bone cholesteatomas. Finally, the fourth section focused on free-choice topics which were assigned to aknowledged experts. The aim of this work was attempting to report the state of the art of the lateral skull base surgery after 50 years of hard work and, above all, to raise questions on those issues which still need an answer, as to allow progress in knowledge through sharing of various experiences. At the end of the reading, if more doubts remain rather than certainties, the aim of this work will probably be achieved.
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Affiliation(s)
- E Zanoletti
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - A Mazzoni
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - A Martini
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - R V Abbritti
- Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France
| | | | - E Alexandre
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - V Baro
- Academic Neurosurgery, Department of Neuroscience DNS, University of Padova Medical School, Padova, Italy
| | - S Bartolini
- Neurosurgery, Bellaria Hospital, Bologna, Italy
| | - D Bernardeschi
- AP-HP, Groupe Hôspital-Universitaire Pitié-Salpêtrière, Neuro-Sensory Surgical Department and NF2 Rare Disease Centre, Paris, France
- Sorbonne Université, Paris, France
| | - R Bivona
- ENT and Skull-Base Surgery Department, Department of Neurosciences, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - M Bonali
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Italy
| | - I Borghesi
- Neurosurgery, Maria Cecilia Hospital, Cotignola (RA), Italy
| | - D Borsetto
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - R Bovo
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - M Breun
- Department of Neurosurgery, Julius Maximilians University Hospital Würzburg, Bavaria, Germany
| | - F Calbucci
- Neurosurgery, Maria Cecilia Hospital, Cotignola (RA), Italy
| | - M L Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - A Caruso
- Gruppo Otologico, Piacenza-Rome, Italy
| | - P Cayé-Thomasen
- The Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - D Cazzador
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
- Department of Neuroscience DNS, Section of Human Anatomy, Padova University, Padova, Italy
| | - P-O Champagne
- Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France
| | - R Colangeli
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - G Conte
- Department of Neuroradiology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - D D'Avella
- Academic Neurosurgery, Department of Neuroscience DNS, University of Padova Medical School, Padova, Italy
| | - G Danesi
- ENT and Skull-Base Surgery Department, Department of Neurosciences, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - L Deantonio
- Department of Radiation Oncology, University Hospital Maggiore della Carità, Novara, Italy
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - L Denaro
- Academic Neurosurgery, Department of Neuroscience DNS, University of Padova Medical School, Padova, Italy
| | - F Di Berardino
- Unit of Audiology, Department of Clinical Sciences and Community Health, University of Milano, Italy
- Department of Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - R Draghi
- Neurosurgery, Maria Cecilia Hospital, Cotignola (RA), Italy
| | - F H Ebner
- Department of Neurosurgery, Eberhard Karls University Tübingen, Germany
| | - N Favaretto
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - G Ferri
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Italy
| | | | - S Froelich
- Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France
| | | | - L Girasoli
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - B R Grossardt
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - M Guidi
- Gruppo Otologico, Piacenza-Rome, Italy
| | - R Hagen
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, "Julius-Maximilians" University Hospital of Würzburg, Bavaria, Germany
| | - S Hanakita
- Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France
| | - D G Hardy
- Department of Neurosurgery, Cambridge University Hospital, Cambridge, UK
| | - V C Iglesias
- ENT and Skull-Base Surgery Department, Department of Neurosciences, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - S Jefferies
- Oncology Department, Cambridge University Hospital, Cambridge, UK
| | - H Jia
- Department of Otolaryngology Head and Neck Surgery, Shanghai Ninh People's Hospital, Shanghai Jiatong University School of Medicine, China
| | - M Kalamarides
- AP-HP, Groupe Hôspital-Universitaire Pitié-Salpêtrière, Neuro-Sensory Surgical Department and NF2 Rare Disease Centre, Paris, France
- Sorbonne Université, Paris, France
| | - I N Kanaan
- Department of Neurosciences, King Faisal Specialist Hospital & Research Center, Alfaisal University, College of Medicine, Riyadh, KSA
| | - M Krengli
- Department of Radiation Oncology, University Hospital Maggiore della Carità, Novara, Italy
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - A Landi
- Academic Neurosurgery, Department of Neuroscience DNS, University of Padova Medical School, Padova, Italy
| | - L Lauda
- Gruppo Otologico, Piacenza-Rome, Italy
| | - D Lepera
- ENT & Skull-Base Department, Ospedale Nuovo di Legnano, Legnano (MI), Italy
| | - S Lieber
- Department of Neurosurgery, Eberhard Karls University Tübingen, Germany
| | - S L K Lloyd
- Department of Neuro-Otology and Skull-Base Surgery Manchester Royal Infirmary, Manchester, UK
| | - A Lovato
- Department of Neuroscience DNS, Audiology Unit, Padova University, Treviso, Italy
| | - F Maccarrone
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Italy
| | - R Macfarlane
- Department of Neurosurgery, Cambridge University Hospital, Cambridge, UK
| | - J Magnan
- University Aix-Marseille, France
| | - L Magnoni
- Unit of Audiology, Department of Clinical Sciences and Community Health, University of Milano, Italy
- Department of Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - D Marchioni
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Verona, Italy
| | | | - G Marioni
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | | | - C Matthies
- Department of Neurosurgery, Julius Maximilians University Hospital Würzburg, Bavaria, Germany
| | - D A Moffat
- Department of Neuro-otology and Skull Base Surgery, Cambridge University Hospital, Cambridge, UK
| | - S Munari
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - M Nardone
- ENT Department, Treviglio (BG), Italy
| | - R Pareschi
- ENT & Skull-Base Department, Ospedale Nuovo di Legnano, Legnano (MI), Italy
| | - C Pavone
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | | | - G Piras
- Gruppo Otologico, Piacenza-Rome, Italy
| | - L Presutti
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Italy
| | - G Restivo
- ENT and Skull-Base Surgery Department, Department of Neurosciences, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - M Reznitsky
- The Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - E Roca
- Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France
| | - A Russo
- Gruppo Otologico, Piacenza-Rome, Italy
| | - M Sanna
- Gruppo Otologico, Piacenza-Rome, Italy
| | - L Sartori
- Academic Neurosurgery, Department of Neuroscience DNS, University of Padova Medical School, Padova, Italy
| | - M Scheich
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, "Julius-Maximilians" University Hospital of Würzburg, Bavaria, Germany
| | - W Shehata-Dieler
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, "Julius-Maximilians" University Hospital of Würzburg, Bavaria, Germany
| | - D Soloperto
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Verona, Italy
| | - F Sorrentino
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - O Sterkers
- AP-HP, Groupe Hôspital-Universitaire Pitié-Salpêtrière, Neuro-Sensory Surgical Department and NF2 Rare Disease Centre, Paris, France
- Sorbonne Université, Paris, France
| | - A Taibah
- Gruppo Otologico, Piacenza-Rome, Italy
| | - M Tatagiba
- Department of Neurosurgery, Eberhard Karls University Tübingen, Germany
| | - G Tealdo
- Department of Neuroscience DNS, Otolaryngology Section, Padova University, Padova, Italy
| | - D Vlad
- Gruppo Otologico, Piacenza-Rome, Italy
| | - H Wu
- Department of Otolaryngology Head and Neck Surgery, Shanghai Ninh People's Hospital, Shanghai Jiatong University School of Medicine, China
| | - D Zanetti
- Unit of Audiology, Department of Clinical Sciences and Community Health, University of Milano, Italy
- Department of Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
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Prasad SC, Piras G, Piccirillo E, Taibah A, Russo A, He J, Sanna M. Surgical Strategy and Facial Nerve Outcomes in Petrous Bone Cholesteatoma. Audiol Neurootol 2016; 21:275-285. [DOI: 10.1159/000448584] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 07/20/2016] [Indexed: 11/19/2022] Open
Abstract
Objective: To review the classification and management of petrous bone cholesteatomas (PBCs) at our center and the outcomes of facial nerve (FN) management in these lesions. Methods: This was a retrospective study. The setting was a quaternary referral center for skull base pathology in Italy. A total of 200 patients with 201 PBCs were included in the study. All patients diagnosed radiologically with PBCs were classified according to the Sanna classification. All patients were surgically treated and followed up with radiology. The main outcome measures - classification of PBCs, the surgical approach used, disease control, and FN outcomes - were analyzed. Results: Supralabyrinthine PBCs were the most common type with 92 cases (45.8%) followed by the massive PBCs with 72 cases (35.8%). Preservation of preoperative FN function was highest in the infralabyrinthine (72.2%) and infralabyrinthine-apical (73.3%) types. The transotic approach was used in 66 cases (32.8%) in this series. The modified transcochlear approach type A was applied in 55 cases (27.3%). Active management of the nerve (rerouting, anastomosis, or grafting) was required in 53 cases (26.4%). Postoperatively, of the 116 cases with FN House-Brackmann grade I and II, 107 cases (92.2%) retained the same grade or improved. Recurrence was seen in 7 cases (3.5%). The mean duration of follow-up was 6.3 years. Conclusions: Radical disease clearance must take precedence over hearing and FN preservation in PBCs. Active FN management, including rerouting, end-to-end anastomosis, and cable nerve grafting, routinely come to play in the surgical management of PBCs, and the postoperative FN results after such interventions can be satisfactory in most cases.
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