A Combined Approach in the Surgery of Infra-Labyrinthine and Infra-Labyrinthine Apical Cholesteatoma: The Comparison of Two Clinical Cases

Diab, Kh. M.; Daikhes, N. A.; Pashchinina, O. A.; Зухба, А.Г.; Panina, O. S.

doi:10.18692/1810-4800-2018-6-130-138

Cited by 2 publications

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“…Соответственно этим классификациям инфралабиринтная холестеатома локализуется в гипотимпануме, может распространяться вперед по инфралабиринтному ячеистому тракту к вертикальному отделу внутренней сонной артерии (ВСА), подвисочной ямке; сзади к задней черепной ямке и сигмовидному синусу; медиально доходить до основания внутреннего слухового прохода (передней поверхности ПВК); вниз до яремного отверстия, вовлекая в процесс луковицу яремной вены (ЛЯВ) и нижние черепно-мозговые нервы (IX/X/XI), канал подъязычного нерва, мыщелок затылочной кости. Инфралабиринтная апикальная холестеатома отличается от предыдущего класса более значительными повреждениями вершины пирамиды с вовлечением ската в верхних и средних отделах [14], каменисто-клиновидного сочленения, клиновидной пазухи, горизонтального отдела ВСА, в исключительно редких случаях -носоглотки.…”

Section: Introductionunclassified

Modified classification of infralabyrinthie cholesteatoma and scale of cholesteatoma extention

Diab

Panina²,

Pashchinina³

2020

Medicinskij sovet

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Introduction. Petrous temporal bone (PTB) cholesteatoma is an epidermal cyst, which is the result of uncontrolled growth of keratinizing squamous epithelium in the petrous part of the temporal bone. Cholesteatoma is classified into congenital, acquired, and iatrogenic.Objective. To discuss the classification of infralabyrinthine petrous bone cholesteatoma (PBC), add modified classificationand to propose adequate differential surgical management.Methods. The setting was a National Medical Scientific Center of Otorhinolaryngology FMBA (Russia). The data of 14 patients who underwent surgery for different variations of infralabyrinthine PBC from 2017 till 2020 were analyzed and included into the study (with respect to localization type of the approach used, complications, recurrences and outcome). The follow-up period ranged from 6 to 34 months with a median of 18 months.Results. Based on preoperative CT scans and intraoperative findings a Scale of Cholesteatoma extension CLIF(APO) and Modified classification of infralabyrinthine cholesteatoma (in relation to mastoid segment of the facial nerve) are proposed. The scale includes the main anatomical structures of the temporal bone and the adjacent parts of the occipital and sphenoid bones, which may be involved in the cholesteatoma process: cochlea, vestibule and semicircular canals, internal auditory canal, jugular foramen, bony chanal of the internal carotid artery, petrous apex, occipital condyle. Based on the modified classification and scale we present an algorithm for decision making and surgical approach choosing.Conclusion. The implementation of the Scale of Cholesteatoma Extension in Otology and Radiology practice will allow to preoperatively diagnose the extension of PBC, unify the data of the localization of cholesteatoma; allows standardization in reporting and continuity at all stages of treatment. The modified classification proposed by us in this article facilitate the algorithm for selecting the type of surgical approach and determine whether to perform less aggressive combined microscopic approaches with endoscopic control.

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Section: Introductionunclassified

Modified classification of infralabyrinthie cholesteatoma and scale of cholesteatoma extention

Diab

Panina²,

Pashchinina³

2020

Medicinskij sovet

Self Cite

View full text Add to dashboard Cite

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Infralabyrinthine petrous bone cholesteatoma (literature review)

Diab

Panina²,

Pashchinina³

2020

Medicinskij sovet

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A literature review on the infralabyrinthine petrous bone cholesteatoma (PBC) was presented in this article. Attention is paid to etiology and clinical symptoms of the disease, classifications. All modern classifications divide cholesteatoma with localization under the labyrinth into two big groups: infralabyrinthine and infralabyrinthine apical. This is not enough to determine the algorithm of surgical tactic of these patients. The most used approaches to the infrlabyrinyhine area and lateral skull base were analyzed (infralabyrinthine and infracochlear, subtotal petrosectomy, transotic approach, group of transcochlear approaches, infratemporal and translabyrinthine approaches). Possible variants of the surgery ending are described (tympanoplasty or “cul-de-sac” closure). Comparison of the results of different authors, starting from 1990, in which the infralabyrinthine cholesteatoma was distinguished as a separate class was carried out. 16 publications were analyzed based on the type of used classification, the total number of cases with infralabyrinthine cholesteatoma, the type of surgical approach, the complications and recurrence rate. The total number of patients was 141, 84 with infralabyrinthine (59,6%), 57 (40,4%) with infralabyrinthine apical PBC. The most common type of surgery were subtotal petrosectomy, transcochlear approach in different variations and transotic approach. The recurrence rate ranged from 0 to 29%. This paper identifies unresolved issues, the necessity of new classification and algorithm of surgical management based on it.

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A Combined Approach in the Surgery of Infra-Labyrinthine and Infra-Labyrinthine Apical Cholesteatoma: The Comparison of Two Clinical Cases

Cited by 2 publications

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Modified classification of infralabyrinthie cholesteatoma and scale of cholesteatoma extention

Modified classification of infralabyrinthie cholesteatoma and scale of cholesteatoma extention

Infralabyrinthine petrous bone cholesteatoma (literature review)

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