Surgical Strategy and Facial Nerve Outcomes in Petrous Bone Cholesteatoma

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.

Sanation of petrous bone cholesteatoma in the otosurgical practice

“…[10] и S. Prasad и соавт. [6], выделяющими супралабиринтный, инфралабиринтный, апикальный, супралабиринтно-апикальный, инфралабиринтно-апикальный, массивный, массивно-апикальный типы.…”

“…В зависимости от распространения холестеатомы пациенты были разделены на группы согласно классификации Moffat-Smith [10] (2008) и M. Sanna [6] (2016) (табл. 3).…”

“…ную приобретенную холестеатому пирамиды височной кости: ятрогенную, развившуюся после хирургических манипуляций на непораженном холестеатомой ухе, и посттравматическую, возникающую в результате эпидермального заноса, вызванного травмой [2,6].…”

“…Хирургические подходы для удаления холестеатомы каменистой части, объем оперативного вмешательства определяются, в первую очередь, степенью распространения заболевания. Анализ существующих хирургических методик удаления холестеатомы пирамиды височной кости выявляет главную тенденцию -полная элиминация холестеатомного матрикса с последующей облитерацией созданной полости аутотканями [6,12,13]. Такая тактика способствует защите жизненно важных структур височной кости и полости черепа, отсутствию формирования больших полостей.…”

Petrous bone cholesteatoma: our experience of 51 patients with emphasis on cochlea preservation and use of endoscope

“…Nowadays, surgery remains the cornerstone for treatment of PBC. The surgical choice has evolved from petromastoid exenteration with drainage of the cavity to complete eradication following obliterative techniques with the effort to protect facial nerve and inner ear [2,5,6]. Despite great advancements in imageology and microscopic skull base surgery technique, PBC surgery is still a challenge to otologists and sometimes the postoperative morbidity remains a disappointing issue.…”