Petrous Bone Cholesteatoma: Classification, Management and Review of the Literature

Sanna, Mario; Pandya, Yash; Mancini, Fernando; Sequino, Giulio; Piccirillo, Enrico

doi:10.1159/000315900

Cited by 101 publications

(132 citation statements)

References 24 publications

(21 reference statements)

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“…At our center all patients with PBCs undergo preoperative high-resolution CT (cuts of 0.6-1 mm) and a cranial MRI with gadolinium enhancement. The PBCs were radiologically staged according to the Sanna classification for PBCs [Pandya et al, 2010;Sanna et al, 1993Sanna et al, , 2011 that has been updated in this study ( fig. 1 ).…”

Section: Methodsmentioning

confidence: 99%

“…PBCs have been shown to be locally aggressive by involving the petrous bone and the areas surrounding it like the clivus, nasopharynx, sphenoid sinus, and infratemporal fossa and even extending intradurally [Lin et al, 2009;Pandya et al, 2010;Rijuneeta et al, 2008;Sanna et al, 1993]. Also, the close proximity of the disease to the labyrinth and the facial nerve (FN) puts to risk both hearing and FN function, which is reflected in the high incidence of FN palsy (34.6-100%) seen in the important series reported in the literature [Kim et al, 2014;Magliulo, 2007;Moffat et al, 2008;Sanna et al, 2011;Yanagihara et al, 1992]. The classification proposed by Sanna et al [Pandya et al, 2010;Sanna et al, 1993Sanna et al, , 2011, which is now widely accepted, divides PBCs into five groups based on the relationship of the disease to the labyrinthine block.…”

Section: Introductionmentioning

confidence: 99%

“…Also, the close proximity of the disease to the labyrinth and the facial nerve (FN) puts to risk both hearing and FN function, which is reflected in the high incidence of FN palsy (34.6-100%) seen in the important series reported in the literature [Kim et al, 2014;Magliulo, 2007;Moffat et al, 2008;Sanna et al, 2011;Yanagihara et al, 1992]. The classification proposed by Sanna et al [Pandya et al, 2010;Sanna et al, 1993Sanna et al, , 2011, which is now widely accepted, divides PBCs into five groups based on the relationship of the disease to the labyrinthine block. This radiological classification allows standardization in reporting and a clear planning of the surgical approach.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical Strategy and Facial Nerve Outcomes in Petrous Bone Cholesteatoma

Prasad¹,

Piras²,

Piccirillo³

et al. 2016

Audiol Neurotol

Self Cite

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“…It is involved by lesions, either primarily (chordoma, chondrosarcoma, cholesterol granuloma) or extension of tumors from neighboring structures (schwannoma, meningioma, paraganglioma, etc.) (1)(2)(3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

Initial Experience With the Retrosigmoid Inframeatal Approach in Skull Base Surgery

et al. 2015

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Introduction:Lesions of the petrous apex involving the inframeatal/infralabyrinthine region are challenging for surgical removal and have a high risk of approach related complications. Traditionally, various extensive skull-base approaches have been used for these lesions. The aim of this study was to present and evaluate our initial experience with a new hearing-preserving extension of the classic retrosigmoid approach to the inframeatal/infralabyrinthine area. Case Presentation: The approach was used in four patients harboring lesions in the petrous apex with variable extension in the inframeatal/infralabyrinthine region. The surgical accessibility of the lesions offered by the approach, completeness of tumor removal, the outcome, in particular, the functional outcome and complication rate, were assessed. Conclusions: The tumor could be gross totally resected in all the four cases. No approach-related morbidities occurred. Serviceable hearing and normal facial nerve functions were preserved in all cases. Our initial experience with the retrosigmoid inframeatal approach revealed that it provides sufficient access to the inframeatal/infralabyrinthine region and offers the possibility of complete tumor removal without any major complications. It allows for hearing and facial nerve functional preservation.

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“…According to Fisch [6], PA cholesteatomas were classified as supralabyrinthine, infralabyrinthine and apical while Sanna et al [7] classified them as supralabyrinthine, infralabyrinthine, massive labyrinthine, infralabyrinthineapical and apical.…”

Section: Introductionmentioning

confidence: 99%

Does Endoscopic Surgery Reduce Recurrence of the Petrous Apex Cholesteatoma?

Kumral

Uyar

Yıldırım

et al. 2013

Indian J Otolaryngol Head Neck Surg

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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.

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Petrous Bone Cholesteatoma: Classification, Management and Review of the Literature

Cited by 101 publications

References 24 publications

Surgical Strategy and Facial Nerve Outcomes in Petrous Bone Cholesteatoma

Surgical Strategy and Facial Nerve Outcomes in Petrous Bone Cholesteatoma

Initial Experience With the Retrosigmoid Inframeatal Approach in Skull Base Surgery

Does Endoscopic Surgery Reduce Recurrence of the Petrous Apex Cholesteatoma?

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