An analysis of petrous bone cholesteatomas treated with translabyrinthine transotic petrosectomy

Tutar, Hakan; Göksu, Nebil; Aydíl, Utku; Tutar, Vildan Baştürk; Kızıl, Yusuf; Bakkal, Faruk Kadri; Bayazıt, Yıldırım A.

doi:10.3109/00016489.2013.811752

Cited by 11 publications

(7 citation statements)

References 8 publications

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“…The thickness of the adventitia is usually sufficient to prevent accidental tearing of the wall, which can result fatal to the patient; carotid stenting is usually not necessary, since no cases of severe hemorrhage are reported in the PBC literature 1217 .For PBC extending beyond the ICA, its gentle mobilization may widen the surgical view of the medial surface under the microscope, but, again, it should only be performed cautiously.Dura materIn PBC, the matrix is usually tightly adherent to the meninges and a loose perimatrix is missing. Bipolar coagulation of dural portions helps removing it or avoiding relapses 134 . In our personal experience, the local application of solutions of mucolytic agents followed by brushing with neurosurgical cottonoids has been proven helpful.…”

Section: Advancements and Open Issuesmentioning

confidence: 99%

“…In PBC, the matrix is usually tightly adherent to the meninges and a loose perimatrix is missing. Bipolar coagulation of dural portions helps removing it or avoiding relapses 134 . In our personal experience, the local application of solutions of mucolytic agents followed by brushing with neurosurgical cottonoids has been proven helpful.…”

Section: Advancements and Open Issuesmentioning

confidence: 99%

“…The recurrence rate for the classical trans-mastoid routes ranges between 5 and 28% in literature 134617 ; long-term observation is needed because relapses have been observed even 8 years after surgery.…”

Section: Advancements and Open Issuesmentioning

confidence: 99%

“…PBC can be congenital, arising from ectodermal embryonic remnants within the otic capsule, acquired (post-otitic), or iatrogenic, after failure of previous middle ear surgery 3 . Histologically the 3 etiological variants are indistinguishable: they all present as a collection of desquamated epithelium, keratin, and cellular debris, sharing similar histologic features with odontogenic keratocysts and epidermal cysts.…”

Section: Introductionmentioning

confidence: 99%

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Surgery of the lateral skull base: a 50-year endeavour

Zanoletti¹,

Mazzoni²,

Martini³

et al. 2019

Acta Otorhinolaryngol Ital

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SUMMARY 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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Section: Advancements and Open Issuesmentioning

confidence: 99%

Section: Advancements and Open Issuesmentioning

confidence: 99%

Section: Advancements and Open Issuesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Surgery of the lateral skull base: a 50-year endeavour

Zanoletti¹,

Mazzoni²,

Martini³

et al. 2019

Acta Otorhinolaryngol Ital

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“…to diagnose all cases of PBCs [Pandya et al, 2010;Sanna et al, 1993Sanna et al, , 2011. This classification has gained widespread acceptance and is used in most of 282 the important series reported in recent times [Alvarez et al, 2011;Aubry et al, 2010a, b;Danesi, et al, 2016;Kim et al, 2014;Magliulo et al, 2007;Pareschi, et al, 2001;Senn et al, 2011;Tutar et al, 2013]. The updated classification ( fig.…”

Section: Terminology and Classificationmentioning

confidence: 99%

Surgical Strategy and Facial Nerve Outcomes in Petrous Bone Cholesteatoma

Prasad¹,

Piras²,

Piccirillo³

et al. 2016

Audiol Neurotol

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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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