Does Endoscopic Surgery Reduce Recurrence of the Petrous Apex Cholesteatoma?

Abstract

The aim of this study is to present the clinical symptoms, complications and treatments of the petrous apex cholesteatoma and is to describe the current role of oto-endoscopy. This was a retrospective non-randomized study of 14 petrous apex cholesteatoma surgeries performed between 1994 and 2012. Petrosectomy was performed according to the location of the cholesteatoma, hearing level of the patients and facial nerve function. Oto-endoscopy was used in the petrous apex and the cerebellopontine angle for residual cholesteatoma. 14 patients, seven were men and seven women were included in this study between 1994-2012. The most common symptom was hearing loss (85.7 %) and tinnitus (50 %) at the presentation. During the surgeries, it was observed that cholesteatoma involved most frequently facial nerve, dura and labyrinthines. Labyrinthectomy, middle cranial fossa approach and petromastoidectomy was performed to these patients. Four of six patients operated without the endoscope assistance between 1994-2006 had recurrences after the operation. These patients were re-operated and in the follow up, there was no recurrence. In the endoscopy assisted surgery, there was no recurrence observed (significance level p = 0.014). The most common complication after the surgery was hearing loss (42.8 %) but it was not significant after surgery (p [ 0.05). The petrous apex and mastoid cavity was obliterated with fat tissue in eight patients while six patients were exteriorized to follow the recurrence and it was insignificant in recurrences (p [ 0.05) Conclusion: Endoscope-assisted surgery allows to remove residual the cholesteatoma around the carotid artery, dura and facial nerve in the petrous apex resulting in less invasive surgery and less recurrence in blind spots.

Giant Petrous Bone Cholesteatoma: Combined Microscopic Surgery and an Adjuvant Endoscopic Approach

“…It must guarantee that the cholesteatoma is visible in its entirety and ensure a sufficient exposure of the middle and posterior fossa dura, carotid artery, lateral sinus, jugular bulb, and facial nerve. 2 5 6 7 8 9 10 11 13 14 15 …”

“…In recent years, endoscopic surgical techniques, instrumentation, and knowledge have greatly improved due to an increased use of endoscopy in middle ear and mastoid surgeries. 9 10 11 …”

“…At present, the main application of endoscopic surgery is in the surgical treatment of middle ear cholesteatoma, but the natural evolution of the technique may provide an increasing number of applications in lateral skull base surgery. 9 10 11 …”

Wholly Endoscopic Permeatal Removal of a Petrous Apex Cholesteatoma

“…Petrous apex cholesteatomas (PACs) can present with hearing loss and a facial palsy with the geniculate ganglion being the most frequently affected part of the facial nerve. Other common presenting features include vertigo, tinnitus, otorrhoea, and otalgia [ 1 , 4 ].…”

“…The inherent complexity of the anatomy of the petrous part of the temporal bone allied with the ability of cholesteatomas to involve other structures makes surgical extirpation less than straightforward. As such, numerous techniques which include the permeatal, transcochlear, transotic, transsphenoidal, and the lateral transtemporal approaches have been developed to reduce both intra- and postoperative complications [ 1 , 2 , 4 , 5 ].…”