Our Experience in the Management of Petrous Bone Cholesteatoma

ABSTRACT

We present the management of a series of petrous bone cholesteatomas. We performed a retrospective analysis on 28 patients with petrous bone cholesteatoma who underwent surgery between 1991 and 2008 at Lariboisiere Hospital, Paris, France. Main outcome measures included age of patients, surgical approaches, complications, and recurrence. The mean age was 47 years. Five were congenital cholesteatomas and 23 were acquired ones. Seventeen patients had undergone previous mastoid surgery elsewhere. Ninety-six percent of patients presented with hearing loss and 37.5% with facial nerve palsy. The surgical approaches varied according to the classification. Postoperatively, four patients developed facial nerve palsy; two patients, XII nerve paresis; one patient, X nerve paresis; and eight patients, deafness. The mean follow-up was 5 years. Twenty patients had no long-term recurrence. Two cases of petrous apex cholesteatoma presenting with double vision were removed by an endoscopic transsphenoidal approach. Control of the lesion was satisfactory in both cases. However, a minor pontic stroke resulted in transient hemiparesis in the case with dehiscent dura around the petrous bone cholesteatoma. Petrous bone cholesteatoma surgery is difficult. Lateral transtemporal and middle fossa approaches are classically used to remove petrous bone cholesteatoma. Recent progresses in endoscopic surgery, using image guidance system, allow removal of the petrous apex cholesteatoma by an endoscopic transsphenoidal approach with minimal morbidity.

KEYWORDS

Petrous bone cholesteatoma - petrous apex - endoscopic transsphenoidal approach

REFERENCES

• 1 Magliulo G. Petrous bone cholesteatoma: clinical longitudinal study.  Eur Arch Otorhinolaryngol. 2007;  264 115-120
• 2 Sanna M, Zini C, Gamoletti R et al.. Petrous bone cholesteatoma.  Skull Base Surg. 1993;  3 201-213
• 3 Moffat D, Jones S, Smith W. Petrous temporal bone cholesteatoma: a new classification and long-term surgical outcomes.  Skull Base. 2008;  18 107-115
• 4 Omran A, De Denato G, Piccirillo E, Leone O, Sanna M. Petrous bone cholesteatoma: management and outcomes.  Laryngoscope. 2006;  116 619-626
• 5 Boko E, Morinière S, Lescanne E, Robier A. [Intrapetrous cholesteatoma. A retrospective study of seven operated cases]. [in French].  Rev Laryngol Otol Rhinol (Bord). 2006;  127 211-216
• 6 Atlas M D, Moffat D A, Hardy D G. Petrous apex cholesteatoma: diagnostic and treatment dilemmas.  Laryngoscope. 1992;  102(12 Pt 1) 1363-1368
• 7 Magliulo G, Terranova G, Sepe C, Cordeschi S, Cristofar P. Petrous bone cholesteatoma and facial paralysis.  Clin Otolaryngol Allied Sci. 1998;  23 253-258
• 8 Yanagihara N, Nakamura K, Hatakeyama T. Surgical management of petrous apex cholesteatoma: a therapeutic scheme.  Skull Base Surg. 1992;  2 22-27
• 9 Keiper Jr G L, Sherman J D, Tomsick T A, Tew Jr J M. Dural sinus thrombosis and pseudotumor cerebri: unexpected complications of suboccipital craniotomy and translabyrinthine craniectomy.  J Neurosurg. 1999;  91 192-197
• 10 Stramandinoli E, Lot G, Herman P, Corre-Gaubert H, Tran Ba Huy P. [Interruption of the lateral sinus in surgery of paraganglioma and acoustic neurinoma. Apropos of 2 complications]. [in French].  Ann Otolaryngol Chir Cervicofac. 1998;  115 362-366
• 11 Gyo K, Jyokou H, Komori M, Zenke K. A case of acquired petrous cholesteatoma associated with insidious middle ear infection treated by staging the surgical procedures.  Auris Nasus Larynx. 1995;  22 192-196
• 12 Komune S, Nakagawa T, Haruta A, Matsuda K, Tono T. Management of cholesteatoma in the petrous apex.  Skull Base Surg. 2000;  10 47-51
• 13 Zanation A M, Snyderman C H, Carrau R L, Gardner P A, Prevedello D M, Kassam A B. Endoscopic endonasal surgery for petrous apex lesions.  Laryngoscope. 2009;  119 19-25
• 14 Mattox D E. Endoscopy-assisted surgery of the petrous apex.  Otolaryngol Head Neck Surg. 2004;  130 229-241
• 15 Georgalas C, Kania R, Guichard J P, Sauvaget E, Tran Ba Huy P, Herman P. Endoscopic transsphenoidal surgery for cholesterol granulomas involving the petrous apex.  Clin Otolaryngol. 2008;  33 38-42
• 16 Chatrath P, Nouraei S A, De Cordova J, Patel M, Saleh H A. Endonasal endoscopic approach to the petrous apex: an image-guided quantitative anatomical study.  Clin Otolaryngol. 2007;  32 255-260