The role of the Transotic approach in cases of Petrous Bone Cholesteatoma

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.

Download Full-text

Extensive Pneumocephalus Secondary to Petrous Bone Cholesteatoma

Ear Nose & Throat Journal ◽

10.1177/01455613211048966 ◽

2021 ◽

pp. 014556132110489

Author(s):

Sultan Alanazy ◽

Sung Il Cho

Keyword(s):

Internal Auditory Canal ◽

Semicircular Canals ◽

Cerebrospinal Fluid Leak ◽

Petrous Bone ◽

Bony Destruction ◽

Fluid Leak ◽

Radiological Studies ◽

Sudden Headache ◽

Transotic Approach ◽

Petrous Bone Cholesteatoma

Pneumocephalus refers to air inside the cranium; however, otogenic pneumocephalus is rarely reported in the literature. The neurological presentations of pneumocephalus include headache, lethargy, confusion, disorientation, and seizure. Here, we have reported a case of a 42-year-old woman with extensive pneumocephalus and cerebrospinal fluid leak secondary to petrous bone cholesteatoma. She presented to the emergency department with sudden headache and left ear discharge. Physical examination revealed watery otorrhea through a hole in the tympanic membrane. Radiological studies demonstrated extensive soft tissue in the left middle ear and mastoid extending to the internal auditory canal. Free intracranial air was observed, and bony destruction was seen in the cochlea, vestibule, and semicircular canals. The patient was managed surgically via the transotic approach and fully recovered. Although otogenic pneumocephalus is rarely encountered in clinical practice, early diagnosis and urgent management are important to prevent fatal complications.

Download Full-text

Infralabyrinthine petrous bone cholesteatoma (literature review)

Medical Council ◽

10.21518/2079-701x-2020-16-140-149 ◽

2020 ◽

pp. 140-149

Author(s):

K. M. Diab ◽

O. S. Panina ◽

O. A. Pashchinina

Keyword(s):

Literature Review ◽

Recurrence Rate ◽

Clinical Symptoms ◽

Petrous Bone ◽

Lateral Skull Base ◽

Number Of Patients ◽

Subtotal Petrosectomy ◽

Comparison Of The Results ◽

Transotic Approach ◽

Petrous Bone Cholesteatoma

A literature review on the infralabyrinthine petrous bone cholesteatoma (PBC) was presented in this article. Attention is paid to etiology and clinical symptoms of the disease, classifications. All modern classifications divide cholesteatoma with localization under the labyrinth into two big groups: infralabyrinthine and infralabyrinthine apical. This is not enough to determine the algorithm of surgical tactic of these patients. The most used approaches to the infrlabyrinyhine area and lateral skull base were analyzed (infralabyrinthine and infracochlear, subtotal petrosectomy, transotic approach, group of transcochlear approaches, infratemporal and translabyrinthine approaches). Possible variants of the surgery ending are described (tympanoplasty or “cul-de-sac” closure). Comparison of the results of different authors, starting from 1990, in which the infralabyrinthine cholesteatoma was distinguished as a separate class was carried out. 16 publications were analyzed based on the type of used classification, the total number of cases with infralabyrinthine cholesteatoma, the type of surgical approach, the complications and recurrence rate. The total number of patients was 141, 84 with infralabyrinthine (59,6%), 57 (40,4%) with infralabyrinthine apical PBC. The most common type of surgery were subtotal petrosectomy, transcochlear approach in different variations and transotic approach. The recurrence rate ranged from 0 to 29%. This paper identifies unresolved issues, the necessity of new classification and algorithm of surgical management based on it.

Download Full-text