Treating cholesteatoma in children is still controversial. This article reviews 93 cases of pediatric cholesteatoma operated on from 1983 to 1991 in the Gruppo Otologico, Placenza, Italy, and details the results in 83 children who underwent the intact canal wall technique. During second-stage surgery, residual cholesteatoma was detected in 38% of patients. Recurrent cholesteatoma was detected in 10% of patients treated with the intact canal wall technique. Residual cholesteatoma was seen in the middle ear cleft in 63%, in the epitympanum in 26%, and in the mastoid in 11% of cases. Social hearing level (< 25 dB) was achieved in 85% of cases with suprastructure, whereas only 53% of patients without suprastructure had these levels. In the treatment of cholesteatoma in children by use of the intact canal wall technique, a preplanned second-look operation is mandatory to eradicate the disease.

Surgery of the skull base, a rapidly developing discipline, warrants a thorough and proper understanding of the complex anatomy of this region. Although phenomenal advances in imaging techniques are invaluable assets, the ultimate necessity of innumerable cadaveric dissections still remains unchallenged in the education of a skull base surgeon. These advances and the increasing awareness of this specialty demand and deserve qualitative improvement in the didactic material used to describe the surgical anatomy of the skull base, an area rich in crucial neurovascular structures.Various techniques have been described before to study the anatomy of the skull base.1'2 We, after years of experience, currently practice a technique for injecting the arteries and veins in fresh temporal bones or fresh cadavers with a simple coloring solution that enables us to obtain a high quality of didactic and scientific material (slides, videotapes) and ultimately helps in the better understanding of the vascular anatomy of the skull base.The aim of this work is to present a simple technique of perfusion of vessels of the skull base in fresh cadavers and temporal bones and to discuss its advantages and disadvantages. TECHNIQUEFresh cadavers or freshly obtained bones preserved in formalin are preferred. The temporal bones are immersed in water for 2 hours to get rid of the unpleasant odor of formalin. The specimens should not be left exposed overnight, as this causes dryness of the dura and soft tissues with subsequent change in their color and increased fragility. The internal jugular vein and the internal carotid artery are identified in the neck. The vertebral artery is dissected and identified, if necessary. A small incision is made on the vessel wall to permit insertion of a suitable sized catheter. The vessels are then repeatedly washed with tap water using a 20 cc syringe so as to remove all the coagula. A perfect and meticulous wash is fundamental in achieving better results as the presence of coagula impedes the entrance of the coloring agent in

Managing patients with failed canal wall down mastoidectomy, requires a meticulous approach to control the disease and restore hearing. The present article reviews the causes of failure of the primary procedure and pitfalls encountered in 105 patients referred to our centre for revision canal wall down mastoidectomy. At post-revision surgery there were no cases with residual or recurrent cholesteatoma. The failures in our revision procedure were due to tympanic membrane perforation which occurred in five percent (n = 4) and intermittent otorrhoea in two percent (n = 2). A dry cavity with adequate middle ear space allowed for optimum audiological function even in revision canal wall down procedures.