Aim: The aim of this article is to discuss the surgical tactic of supralabyrinthine and infralabyrinthine petrous bone cholesteatoma.
Study Design: Retrospective analysis has been conducted.
Setting: National Medical Scientific Center of Otorhinolaryngology FMBA (Russia).
Materials and Methods: A total of 28 patients (30 surgeries) were included in the retrospective study. The canal wall down (CWD) transmastoid approach was used in 10 cases and combined CWD with middle fossa approach was performed in 3 cases (27%) in patients with supralabyrinthine and supralabyrinthine apical PBCs. The infralabyrinthine retrofacial approach was used in 4 cases (27%). After CWD procedure, the combined infracochlear approach using micro-, endoscopic technique was applied in 3 cases (20%). The combined transcochlear approach was used in 6 cases. In two cases with extensive destruction of internal auditory canal (IAC) (13%) we had to perform translabyrinthine approach.
Results: Good functional results were obtained: hearing preservation in 11 patients; postoperatively 9 patients with facial nerve palsy retained the same grade or improved; lower cranial nerve function was preserved in all cases, even if both parts of the jugular foramen were destroyed. Recurrence and residual cholesteatoma were seen totally in 5 cases, which were reoperated later on without signs of recidivism. The mean duration of a follow-up was 18 months.
Conclusion:
Surgical planning based on precision study of preoperative CT data, taking into account the peculiarity of localization and extension of the process, and presence of middle cranial fossa (MCF) defects allows to successfully eliminate the pathological process with the possibility of minimizing injuries of vital structures and to get reliable closure of bone defects between the postoperative cavity and MCF. Preservation of the auditory function in patients with supralabyrinthine and infralabyrinthine cholesteatoma is possible in less than half percent of cases.
The use of video endoscopic assistant, monitoring of the cranial nerves is mandatory and in some cases allows to preserve the hearing and facial nerve function, visualize and prevent injuries of V, VII, IX–XII pairs of cranial nerves.
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