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Pace A, Visconti IC, Iannella G, Milani A, Rossetti V, Cocuzza S, Maniaci A, Messineo D, Magliulo G. Petrous Bone Cholesteatoma: Facial and Hearing Preservation. EAR, NOSE & THROAT JOURNAL 2024; 103:NP374-NP381. [PMID: 34797992 DOI: 10.1177/01455613211056554] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: Petrous bone cholesteatoma (PBC) is a rare condition of the petrous portion of the temporal bone. Treatment of choice consists of radical surgical removal, paying attention to protect the facial nerve and inner ear as far as possible. The aim of the present study was to evaluate the efficacy of modified translabyrinthine techniques in preserving hearing function and the use of the adjuvant endoscopic techniques in a group of PBC patients. Methods: This study comprised 16 cases of PBCs surgically treated in our Department. Pre- and post-operative hearing status was assessed with pure tone audiometry and speech discrimination and graded according to the Gardner- Robertson classification system. Facial function was based on the House Brackman (HB) classification. PBCs were grouped using Sanna's classification. The choice of surgical technique was based on the above findings together with preoperative evidence. Post-operative follow-up ranged from 1 to 10 years and also included Computed Tomography and Magnetic Resonance Imaging assessment. Results: PBCs were classified as follows: 37.5% infralabyrinthine; 43.75% supralabyrinthine; and 18.75% massive. Preservation of the bone conduction threshold was feasible in 62.5% of patients. For supralabyrinthine PBCs a subtotal petrosetomy was performed in all cases and hearing preservation was possible in 57% of them: an adjuvant endoscopic approach was performed in 43%. Infralabyrinthine PBCs were treated using a modified translabyrinthine approach with preservation of bone conduction in 83% of patients; an adjuvant endoscopic approach was performed in 50% cases. One patient with a massive cholesteatoma was treated by modified translabyrinthine approach, preserving a serviceable level of hearing. In all massive cases, an adjuvant endoscopic approach was performed. In 2 patients with preoperative palsy, facial nerve function showed an improvement. The follow-up period revealed evidence of limited recurrence at CT imaging in 2 patients. Conclusions: The introduction of modified surgical approaches, able to preserve the anatomical-functional structures, have shown an improvement of post-operative hearing outcomes.
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Affiliation(s)
- Annalisa Pace
- Scienze Chirurgiche Department, Sapienza University of Rome, Italy
| | | | | | | | | | | | | | - Daniela Messineo
- Scienze Radiologiche, Oncologiche e Anatomo-Patologiche Department, Sapienza University of Rome, Italy
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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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Shkarubo AN, Chernov IV, Andreev DN, Yu Bezborodova T, Turkin AM. [Endoscopic transnasal approach in surgical treatment of petrous temporal bone cholesteatoma extending towards the clivus. Three clinical observations and literature review]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2022; 86:97-102. [PMID: 35412718 DOI: 10.17116/neiro20228602197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
UNLABELLED Petrous temporal bone Cholesteatoma is widely described in the literature and accounts for up to 9% of all neoplasms of this localization. These cholesteatomas rarely spread towards the clivus. Isolated clival cholesteatomas are described only as single cases. There is currently no consensus on the choice of surgical approach for resection of similar neoplasms. OBJECTIVE To demonstrate the possibilities of endoscopic transnasal approach in surgery for clival and petrous cholesteatoma. MATERIAL AND METHODS This article presents 3 clinical cases: 2 patients with apical cholesteatoma of petrous part of temporal bone extending to the clivus and 1 patient with massive petrous temporal bone cholesteatoma extending towards the clivus according to the classification of Sanna M. All patients underwent endoscopic transnasal surgery. RESULTS AND CONCLUSION In our opinion, endoscopic transnasal approach is optimal for resection of similar neoplasms. Total and subtotal resection was performed in 2 and 1 case, respectively. However, there are certain limitations of this approach in accessing the most lateral parts of the neoplasm. Nevertheless, endoscopic transnasal approach ensures resection of petrous temporal bone cholesteatoma extending to the clivus without the risk of damage to acoustic-facial cranial nerves. It is especially significant in patients without their baseline dysfunction.
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Affiliation(s)
| | - I V Chernov
- Burdenko Neurosurgical Center, Moscow, Russia
| | - D N Andreev
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - A M Turkin
- Burdenko Neurosurgical Center, Moscow, 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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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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Copelli C, Catapano D, Manfuso A, d'Ecclesia A. Trismus and TMJ disorders as first clinical manifestations in an intracranial acquired cholesteatoma. BMJ Case Rep 2021; 14:14/5/e242460. [PMID: 34059547 DOI: 10.1136/bcr-2021-242460] [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: 11/03/2022] Open
Abstract
Intracranial extension of acquired cholesteatoma is a rare occurrence that can develop secondary to trauma, chronic otitis media or acquired aural cholesteatoma. The most commonly observed symptoms are headache and hearing loss. The authors report on a rare case of intracranial cholesteatoma presenting with atypic symptoms: swelling and temporomandibular joint disorders.
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Affiliation(s)
- Chiara Copelli
- Head and Neck Department, Operative Unit of Maxillo-Facial Surgery and Otolaryngology, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Puglia, Italy
| | - Domenico Catapano
- Head and Neck Department, Operative Unit of Neurosurgery, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Puglia, Italy
| | - Alfonso Manfuso
- Head and Neck Department, Operative Unit of Maxillo-Facial Surgery and Otolaryngology, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Puglia, Italy
| | - Aurelio d'Ecclesia
- Head and Neck Department, Operative Unit of Maxillo-Facial Surgery and Otolaryngology, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Puglia, Italy
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9
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Endoscopic transnasal removal of cholesteatomas of the temporal bone pyramid with extension to the clivus. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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10
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Orhan KS, Çelik M, Polat B, Aydemir L, Aydoseli A, Sencer A, Güldiken Y. Endoscope-Assisted Surgery for Petrous Bone Cholesteatoma with Hearing Preservation. J Int Adv Otol 2020; 15:391-395. [PMID: 31846917 DOI: 10.5152/iao.2019.7212] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Petrous bone cholesteatoma is a rare pathologic entity and may be a difficult surgical challenge because of potential involvement of the facial nerve, carotid artery, dura mater, otic capsule and superior petrosal or lateral sinus. The objective of this article is to present the endoscope-assisted surgery for petrous bone cholesteatoma. MATERIALS AND METHODS Eight patients (nine ears) who underwent endoscope-assisted petrous bone surgery for cholesteatoma. Pure tone audiogram, magnetic resonance imaging were performed at preoperatively, and at approximately 12 months postoperatively. RESULTS Endoscope assisted surgery was performed in 8 patients and 9 ears. Of these patients, 6 were male and 2 were females. Median age was 19,5 (range 7-52) years. Hearing was able to preserved in 8 ears (8/9). Recurrence disease was observed one ear in long term follow up (1/9). In another one patient, cholesteatoma pearl was removed in the office. CONCLUSION Endoscope-assisted surgery can allow removal of cholesteatoma of petrous apex with preserving hearing. It also provides to remove the cholesteatoma via transmastoid approach for perilabyrinthine space as "minimally invasive surgery" instead of middle fossa approach that is standard surgical procedure. In apical and peri-labyrinthine cholesteatomas, endoscopes allow to preserve hearing with middle fossa approach instead of trans-otic/ trans-labyrinthine/trans-cochlear approach.
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Affiliation(s)
- Kadir Serkan Orhan
- Department of Otorhinolaryngology, İstanbul University School of Medicine, İstanbul, Turkey
| | - Mehmet Çelik
- Department of Otorhinolaryngology, İstanbul University School of Medicine, İstanbul, Turkey
| | - Beldan Polat
- Department of Otorhinolaryngology, İstanbul University School of Medicine, İstanbul, Turkey
| | - Levent Aydemir
- Department of Otorhinolaryngology, İstanbul University School of Medicine, İstanbul, Turkey
| | - Aydın Aydoseli
- Department of Neurosurgery, İstanbul University School of Medicine, İstanbul, Turkey
| | - Altay Sencer
- Department of Neurosurgery, İstanbul University School of Medicine, İstanbul, Turkey
| | - Yahya Güldiken
- Department of Otorhinolaryngology, İstanbul University School of Medicine, İstanbul, Turkey
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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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Sharma SC, Panda S, Thakar A, Devaraja K. Petrous Bone Cholesteatoma: Radical Excision with an Endeavour for Hearing Preservation. Indian J Otolaryngol Head Neck Surg 2019; 71:1572-1579. [PMID: 31750219 DOI: 10.1007/s12070-019-01662-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 04/20/2019] [Indexed: 11/27/2022] Open
Abstract
To describe surgical outcomes following resection of giant petrous bone cholesteatoma. Retrospective cohort study was undertaken at a tertiary care centre on patients who had undergone surgery for petrous bone cholesteatoma (PBC) from August 2014 to September 2017. For patients with serviceable hearing preoperatively, labyrinth preserving techniques, namely, modified transmastoid translabyrinthine approach (massive PBC-1) and supralabyrinthine approach (supralabyrinthine PBC-1) were considered. In the former, bony labyrinth which had been destroyed due to the disease process, membranous labyrinth remained anatomically and functionally intact following meticulous dissection to remove cholesteatoma matrix. In the latter, supralabyrinthine cell tracts were exenterated without disturbing the cochlea and labyrinth with a canal wall down mastoidectomy. For the remaining patients, labyrinth ablative approach was undertaken (translabyrinthine/transotic). Facial nerve function was evaluated using House-Brackman grading system. Hearing was evaluated using pure tone audiometry. 7 patients were identified (massive-2, supralabyrinthine-3, supralabyrinthine apical-1, infralabyrinthine apical 1). None of the patients experienced deterioration of postoperative bone conduction or facial nerve function (preop-grade 5-4, grade 6-3; postop-grade 2-1, grade 3-2, grade 4-4). Facial nerve was decompressed and anatomically intact in 3 cases. In the remaining, facial hypoglossal anastomosis was done in 3 and facial masseteric anastomosis was done in 1 patient. With a median follow-up of 26 months, recurrence in the form of keratin pearl was seen in 1 patient. Modified translabyrinthine approach preserving membranous labyrinth is a promising hearing preservation strategy.
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Affiliation(s)
- Suresh C Sharma
- 1Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Teaching Block, 4th Floor, AIIMS, Ansari Nagar, East, New Delhi, 110029 India
| | - Smriti Panda
- 1Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Teaching Block, 4th Floor, AIIMS, Ansari Nagar, East, New Delhi, 110029 India
| | - Alok Thakar
- 1Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Teaching Block, 4th Floor, AIIMS, Ansari Nagar, East, New Delhi, 110029 India
| | - K Devaraja
- 2Department of Otolaryngology and Head and Neck Surgery, Kasturba Medical College, Mangalore, India
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Sanna Classification and Prognosis of Cholesteatoma of the Petrous Part of the Temporal Bone: A Retrospective Series of 81 Patients. Otol Neurotol 2017; 37:787-92. [PMID: 26808555 DOI: 10.1097/mao.0000000000000953] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine how classification of petrous bone cholesteatomas (PBCs) using the 5-point Sanna classification can predict major structural involvement, facial nerve outcomes, hearing outcomes, postoperative complications, and disease recurrence. STUDY DESIGN Retrospective case series. SETTING Tertiary referral center in Bergamo, Italy. PATIENTS Eighty-one sequential patients with radiologic and surgically confirmed diagnoses of PBC treated at a single tertiary referral center during a 20-year period. MAIN OUTCOME MEASURES Major structural involvement, facial nerve outcomes, hearing outcomes, postoperative cerebrospinal fluid leak, and disease recurrence were evaluated on the basis of Sanna classification. RESULTS Using the Sanna classification, 70% (57) were supralabyrinthine, 12% (10) infralabyrinthine, 7% (6) infralabyrinthine-apical, 5% (4) apical, and 5% (4) massive. Massive classification was statistically significantly associated with cochlear involvement (p = 0.009) and internal auditory canal involvement (p = 0.02). The infralabyrinthine-apical class was associated with carotid canal involvement (p = 0.03). Facial nerve interruption was observed in 35% of patients and most frequently in the apical group (75%). Neither hearing nor facial nerve outcomes were associated with Sanna classification. House-Brackmann score improved or was maintained postoperatively in 89% of patients. CONCLUSION The Sanna classification provides anatomic detail on location of PBCs and is predictive of IAC, cochlear, and carotid artery involvement. However, classification systems for this rare condition continue to pose a challenge in being able to accurately predict facial nerve and hearing outcomes in surgical obliteration of PBC.
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15
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Prasad SC, Roustan V, Piras G, Caruso A, Lauda L, Sanna M. Subtotal petrosectomy: Surgical technique, indications, outcomes, and comprehensive review of literature. Laryngoscope 2017; 127:2833-2842. [DOI: 10.1002/lary.26533] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 01/18/2017] [Accepted: 01/23/2017] [Indexed: 11/11/2022]
Affiliation(s)
| | - Valeria Roustan
- Department of Otology and Skull Base Surgery; Otological Group; Piacenza-Rome Italy
| | - Gianluca Piras
- Department of Otology and Skull Base Surgery; Otological Group; Piacenza-Rome Italy
| | - Antonio Caruso
- Department of Otology and Skull Base Surgery; Otological Group; Piacenza-Rome Italy
| | - Lorenzo Lauda
- Department of Otology and Skull Base Surgery; Otological Group; Piacenza-Rome Italy
| | - Mario Sanna
- Department of Otology and Skull Base Surgery; Otological Group; Piacenza-Rome 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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17
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Garov EV, Zelenkova VN, Zelenkov AV, Mit'kovsky SV. [The surgical treatment of cholesteatoma of the pyramid of the temporal bone]. Vestn Otorinolaringol 2015; 80:57-60. [PMID: 26288213 DOI: 10.17116/otorino201580357-60] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This paper presents in brief the data on epidemiology, classification, diagnostics, and current tendencies in the surgical treatment of cholesteatoma of the pyramid of the temporal bone. A clinical case of diagnostics and the surgical treatment ofpetrous apex cholesteatomainthe temporal bone is described.
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Affiliation(s)
- E V Garov
- L.I. Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow Health Department, Moscow, Russia, 117152
| | - V N Zelenkova
- L.I. Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow Health Department, Moscow, Russia, 117152
| | - A V Zelenkov
- A.I. Burnazyan Federal Medico-Biological Centre, Russian Federal Nedico-Biological Agency, Moscow, Russia 123098
| | - S V Mit'kovsky
- A.I. Burnazyan Federal Medico-Biological Centre, Russian Federal Nedico-Biological Agency, Moscow, Russia 123098
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Vashishth A, Singh Nagar TR, Mandal S, Venkatachalam VP. Extensive intratemporal cholesteatomas: presentation, complications and surgical outcomes. Eur Arch Otorhinolaryngol 2013; 272:289-95. [PMID: 24318471 DOI: 10.1007/s00405-013-2852-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 11/30/2013] [Indexed: 11/30/2022]
Abstract
The purpose of the study was to review the clinical features, complications, surgical management and post-operative outcomes of medially invasive extensive cholesteatomas and intracranial complications of cholesteatoma. The retrospective review was carried out at a tertiary referral center and included 20 patients presenting with extensive intratemporal cholesteatomas between 2011 and 2013. Inclusion criteria were involvement of the labyrinth, facial nerve, posterior fossa dura and intracranial complications. The mean age of the patients was 20 years. Profuse foul-smelling otorrhoea and severe otalgia/temporal headache were the most common presenting features. Intracranial complications were observed in nine patients, most commonly temporal lobe abscess; 14/20 patients exhibited profound hearing loss. One case exhibited massive labyrinthine petrous apex cholesteatoma. Labyrinthine destruction was seen in all cases of facial nerve involvement. Management of intracranial complications preceded canal wall-down mastoidectomy with or without partial labyrinthectomy and subtotal petrosectomy (transotic) with blind sac closure for petrous cholesteatoma. Facial nerve infiltration was observed in one case, whereas eight cases exhibited gross dehiscence of the fallopian canal. Disease clearance was complete in all cases with two mortalities in patients with intracranial complications. Post-operative course was uncomplicated in all other patients apart from a case of wound dehiscence. All patients remain disease free after a minimum and maximum follow-up of 6 months and 2 years, respectively. Extensive intratemporal cholesteatomas and intracranial complications caused by them continue to pose a challenge to the management of otitis media in the current era and merit early recognition, surgical management and follow-up.
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Affiliation(s)
- Ashish Vashishth
- Department of ENT and Head and Neck Surgery, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India,
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