Giant Petrous Bone Cholesteatoma: Combined Microscopic Surgery and an Adjuvant Endoscopic Approach

Iannella, Giannicola; Savastano, Ersilia; Pasquariello, Benedetta; Re, Massimo; Magliulo, Giuseppe

doi:10.1055/s-0035-1571205

Cited by 26 publications

(16 citation statements)

References 17 publications

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“…This surgical technique is suitable for chronic otitis media, malformations of the auditory ossicles, traumatic damage to the ossicles, cholesteatomatous otitis media, otoslcerosis, and other diseases [1][2][3][4][5][6] . Similarly, the number of papers reporting the advantages of endoscopic middle ear visualization has also been increasing in the last years [6][7][8][9] .…”

Section: Introductionmentioning

confidence: 99%

Endoscopic vs Microscopic Approach in Stapes Surgery: Advantages in the Middle Ear Structures Visualization and Trainee's Point of View

Iannella

Marcotullio²,

Re³

et al. 2017

Int Adv Otol

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OBJECTIVE:Comparing the endoscopic and microscopic approaches in stapes surgery, and establishing the surgical approach that allows better results in terms of visualization of the middle ear structures and aids assistant's training. MATERIALS and METHODS:Twenty-one residents from the first to the fifth year of training in Otolaryngology were enrolled in this prospective study. A questionnaire specifically designed to investigate the understanding of middle ear anatomy, the surgical steps, and a personal opinion about endoscopic stapes surgery was submitted to each resident. RESULTS:Statistical differences between the endoscopic and microscopic approaches were evident about identification of stapes and long process of the incus (p=0.03) and stapes footplate and the oval window (p=0.03). No substantial difference between the two surgical approaches emerged regarding the visualization of the tympanic membrane and the other middle ear structures (p>0.5). A substantial difference in favor of the endoscopic approach emerged regarding the identification of the hole creation in the footplate of the stapes. CONCLUSION:Endoscopic stapes surgery could favor an easier understanding of the surgical technique for assistants in training with little knowledge of the anatomy and surgical steps.

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Section: Introductionmentioning

confidence: 99%

Endoscopic vs Microscopic Approach in Stapes Surgery: Advantages in the Middle Ear Structures Visualization and Trainee's Point of View

Iannella

Marcotullio²,

Re³

et al. 2017

Int Adv Otol

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“…A number of surgical techniques have been reported in the literature. These include infra-labyrinthine, middle cranial fossa, retrosigmoid, transotic, and translabyrinthine approaches [ 1 – 3 , 9 , 10 ]. Obviously, the choice of the best surgical approach depends on the extension of the disease and on preoperative otoscopic and radiological findings.…”

Section: Discussionmentioning

confidence: 99%

Tympanic Cholesterol Granuloma and Exclusive Endoscopic Approach

Angeletti

Pace²,

Iannella³

et al. 2020

Am J Case Rep

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Patient: Male, 65-year-old Final Diagnosis: Tympano-mastoid cholesterol granuloma Symptoms: Hearing impairment Medication:— Clinical Procedure: Endoscopic surgery of the ear Specialty: Otolaryngology Objective: Unusual or unexpected effect of treatment Background: Cholesterol granuloma is a histological entity containing cholesterol crystals surrounded by foreign-body giant cells and chronic inflammation. Tympanic cholesterol granuloma is a rare disease, while petrous bone cholesterol granuloma is more common. Surgery consists of elective management in most cases of CGs. There are several types of surgery described to treat cholesterol granuloma; however, a case treated by primary endoscopic ear surgery has not yet been described. The aim of this case report is to present the endoscopic characteristics of cholesterol granulomas and show how endoscopic ear surgery is possible in isolated and selected cases with this pathology. Case Report: We report the case of a 65-year-old patient affected by a cholesterol granuloma of the middle ear, with progressive hearing impairment and fullness of the left ear. The granuloma was diagnosed via medical imaging using magnetic resonance imaging, which identified the typical high signal intensity in T1- and T2-weighted images. In this case, cholesterol granuloma was limited to the epitympanic and mesotympanic regions. For small cholesterol granulomas confined to the middle ear, a canal wall-up or wall-down tympanoplasty plus ventilation tube insertion are usually performed. In this case, primary endoscopic surgery was performed under general anaesthesia to remove the presumed cholesterol granuloma. It was completely removed by this approach, without facial nerve injuries or postoperative complications. The patient had no disease recurrence at clinical and radiological investigation at 1-year follow-up. Conclusions: An exclusive endoscopic approach to remove cholesterol granuloma is feasible. However, it should only be performed in selected cases.

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“…All these results strongly suggest that cochlea should be preserved with great effort during PBC resection for future hearing rehabilitation. Since Mattox first reported using endoscope to assist the traditional microsurgery for treatment of petrous lesion in 2004 [17], literature about endoscope assistant PBC excision has increased significantly [18,19]. Compared with microscope, the main advantage of endoscope is it can greatly enhance visualization and surgical precision.…”

Section: Discussionmentioning

confidence: 99%

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

Gao

Zhang

et al. 2019

Acta Oto-Laryngologica

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Background: Petrous bone cholesteatoma (PBC) is a rare but local aggressive lesion which can lead to severe complications. Surgery is the mainstay for its treatment. Objectives: To analyse the clinical characteristics and surgical outcomes in a series of patients with PBC, paying special attention to cochlea preservation and use of endoscope. Materials and methods: Retrospective study of 51 patients with PBC who underwent surgery at our centre. Results: Hearing loss (72.5%) and facial paralysis (58.8%) were the two most common symptoms. According to Sanna's classification, supralabyrinthine subtype (51.0%) was the most common subtype, followed by the massive subtype (33.3%). In most patients, PBC was radically removed using subtotal petrosectomy (80.4%). Endoscope was used for assistance in six cases. Various managements of facial nerve were used in different cases. Hearing rehabilitation was not emphasized (44 postoperative dead ear); however, cochlea was preserved as far as possible (45.3%). Recurrence was identified in five patients by MRI with diffusion weighted imaging (DWI) sequence. No recurrence was detected in patients underwent surgery with endoscope assistance. Conclusions and significance: radical excision and functional reconstruction constitute the framework of PBC surgery. Cochlea preservation is critical for possible cochlear implantation in the future. Use of endoscope has the potential to enhance surgical precision and reduce recurrence. ARTICLE HISTORY

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Giant Petrous Bone Cholesteatoma: Combined Microscopic Surgery and an Adjuvant Endoscopic Approach

Cited by 26 publications

References 17 publications

Endoscopic vs Microscopic Approach in Stapes Surgery: Advantages in the Middle Ear Structures Visualization and Trainee's Point of View

Endoscopic vs Microscopic Approach in Stapes Surgery: Advantages in the Middle Ear Structures Visualization and Trainee's Point of View

Tympanic Cholesterol Granuloma and Exclusive Endoscopic Approach

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

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