Management of Complex Cases of Petrous Bone Cholesteatoma

Pandya, Yash; Piccirillo, Enrico; Mancini, Fernando; Sanna, Mario

doi:10.1177/000348941011900803

Cited by 37 publications

(31 citation statements)

References 6 publications

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“…Infratemporal fossa approach type B has to be used for further extension of cholesteatoma into the clivus, sphenoid sinus, or rhinopharynx. 8) One of our cases had a meningoencephalocele after prior cholesteatoma resection without bone reconstruction, suggesting the importance of bony repair in cases with large defects of the skull base. Meningoencephalocele or meningocele with or without CSF leakage have also been reported.…”

Section: Discussionmentioning

confidence: 79%

“…Many reconstruction materials were applied for the repair of the middle cranial fossa after extensive removal of the skull base, such as temporal muscle fascia, autologous bone, conchal cartilage, titanium mesh, silicone, and hydroxyapatite cement. 3,7,8) The incidence of infection and extrusion of the materials was higher when synthetic materials were used 3) ; therefore, we selected autologous divided calvarial bone to avoid postoperative infection because this operative site communicates with the middle ear and remains in substerile condition during and after the operation.…”

Section: Discussionmentioning

confidence: 99%

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Combined Transmastoid/Middle Fossa Approach for Intracranial Extension of Middle Ear Cholesteatoma

Tabuchi

Yamamoto

Akutsu

et al. 2012

Neurol. Med. Chir.(Tokyo)

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A retrospective review was performed of patients treated for middle ear cholesteatoma with bone defects of the skull base via a combined transmastoid/middle fossa approach at the University of Tsukuba Hospital from 2006 through 2011 to determine the safety and effectiveness of a combined transmastoid/middle fossa approach for the treatment of cholesteatoma involving the middle cranial fossa. The bone defects of the skull base were reconstructed with a galeal flap pedicled with a parietal branch of the superficial temporal artery and an autologous bone flap. The clinical and radiological data were analyzed. This series included 8 patients (6 men and 2 women) with a mean age of 46.3 years (range 10-67 years). One of the patients preoperatively exhibited meningoencephalocele of the middle fossa skull base, and in the remaining 7 patients, petrous bone involvement such as involvement of the supralabyrinthine cells was observed. The cholesteatoma lesion was totally removed and inner ear function preserved in all the patients. Cerebrospinal fluid leakage was observed in 1 patient during and after the surgery. Neither meningitis nor recurrence was observed in any patient during the follow-up periods (mean 29.4 months, range 6-64 months). The combined transmastoid/middle fossa approach allowed complete removal of cholesteatoma with middle cranial fossa involvement while preserving hearing and preventing postoperative cerebrospinal fluid leakage and meningitis.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Combined Transmastoid/Middle Fossa Approach for Intracranial Extension of Middle Ear Cholesteatoma

Tabuchi

Yamamoto

Akutsu

et al. 2012

Neurol. Med. Chir.(Tokyo)

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“…At our center all patients with PBCs undergo preoperative high-resolution CT (cuts of 0.6-1 mm) and a cranial MRI with gadolinium enhancement. The PBCs were radiologically staged according to the Sanna classification for PBCs [Pandya et al, 2010;Sanna et al, 1993Sanna et al, , 2011 that has been updated in this study ( fig. 1 ).…”

Section: Methodsmentioning

confidence: 99%

“…The rarity of these lesions, their slow and silent growth pattern, their complex location in the skull base, their proximity to vital neurovascular structures, and their tendency to recur make PBCs very challenging to diagnose and treat. PBCs have been shown to be locally aggressive by involving the petrous bone and the areas surrounding it like the clivus, nasopharynx, sphenoid sinus, and infratemporal fossa and even extending intradurally [Lin et al, 2009;Pandya et al, 2010;Rijuneeta et al, 2008;Sanna et al, 1993]. Also, the close proximity of the disease to the labyrinth and the facial nerve (FN) puts to risk both hearing and FN function, which is reflected in the high incidence of FN palsy (34.6-100%) seen in the important series reported in the literature [Kim et al, 2014;Magliulo, 2007;Moffat et al, 2008;Sanna et al, 2011;Yanagihara et al, 1992].…”

Section: Introductionmentioning

confidence: 99%

“…Also, the close proximity of the disease to the labyrinth and the facial nerve (FN) puts to risk both hearing and FN function, which is reflected in the high incidence of FN palsy (34.6-100%) seen in the important series reported in the literature [Kim et al, 2014;Magliulo, 2007;Moffat et al, 2008;Sanna et al, 2011;Yanagihara et al, 1992]. The classification proposed by Sanna et al [Pandya et al, 2010;Sanna et al, 1993Sanna et al, , 2011, which is now widely accepted, divides PBCs into five groups based on the relationship of the disease to the labyrinthine block. This radiological classification allows standardization in reporting and a clear planning of the surgical approach.…”

Section: Introductionmentioning

confidence: 99%

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Surgical Strategy and Facial Nerve Outcomes in Petrous Bone Cholesteatoma

Prasad¹,

Piras²,

Piccirillo³

et al. 2016

Audiol Neurotol

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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.

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