Scientific Online Resource System

Conference Proceedings

Supralabyrinthine And Infralabyrinthine Petrous Bone Cholesteatoma: Experience In Treatment In National Medical Research Center Of Otorhinolaryngology, Russia

Khassan Diab, Nikolay Daikhes, Olga Pashchinina, Olga Panina, Svetlana Kokhaniuk

Abstract

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.


Keywords

skull base surgery, supralabyrinthine cholesteatoma, facial nerve

Full Text


References

Omran A, De Denato G, Piccirillo E, Leone O, Sanna M. Petrous bone cholesteatoma: management and outcomes. Laryngoscope. 2006;116(4):619-626. doi:https://doi.org/10.1097/01.mlg.0000208367.03963.ca

Olszewska E, Wagner M, Bernal-Sprekelsen M, Ebmeyer J, Dazert S, Hildmann H et al. Etiopathogenesis of cholesteatoma. Eur Arch Otorhinolaryngol. 2004;261(1):6-24. doi: https://doi.org/10.1007/s00405-003-0623-x

Sanna M, Zini C, Gamoletti R, Frau N, Taibah A, Russo A, Pasaninci E: Petrous bone cholesteatoma. Skull Base Surg. 1993; 3; 201-213.DOI: 10.1055/s-2008-1060585

Prasad SC, Piras G, Piccirillo E, et al. Surgical Strategy and Facial Nerve Outcomes in Petrous Bone Cholesteatoma. AudiolNeurootol. 2016;21(5):275-285. doi:https://doi.org/10.1159/000448584

Levenson MJ, Michaels L, Parisier SC, Juarbe C. Congenital cholesteatomas in children: an embryologic correlation. Laryngoscope. 1988 Sep;98(9):949–955. DOI: 10.1288/00005537-198809000-00008

Potsic WP, Samadi DS, Marsh RR, Wetmore RF. A staging system for congenital cholesteatoma. ArchOtolaryngolHeadNeckSurg. 2002;128(9):1009-1012. doi:https://doi.org/10.1001/archotol.128.9.1009

Fisch U. Infratemporal fossa approach for extensive tumors of the temporal bone and base of skull. In: Silverstein H, Norell N, eds. Neurological Surgery of the Ear.Birmingham, AL: Aesculapius; 1977:33–53. DOI: 10.1001/archotol.1979.00790140045008

Bartels LJ. Facial nerve and medially invasive petrous bone cholesteatomas. AnnOtolRhinolLaryngol.1991;100:308– 316. DOI: 10.1177/000348949110000408

Sanna M, Pandya Y, Manchini F, Sequino G, Piccirillo E: Petrous bone cholesteatoma: classification, management and review of literature. AudiolNeurotol. 2011; 16; 124-136.DOI: 10.1159/000315900

Moffat D, Jones S, Smith W: Petrous bone cholesteatoma: a new classification and long-term surgical outcomes. Skull Base.2008; 18:107-115 DOI: 10.1055/s-2007-991112

Magliulo G. Petrous bone cholesteatoma: clinical longitudinal study. Eur Arch Otorhinolaryngol. 2007; 264(2):115‐120. doi:10.1007/s00405-006-0168-x

Magliulo G., Terranova G., Sepe C., Cordeschi S., Cristofar P. Petrous bone cholesteatoma and facial paralysis. Clin Otolaryngol Allied Sci. 1998; 23(3):253‐258. doi:10.1046/j.1365-2273.1998.00144.x

Geven L.I., Mulder J.J., Graamans K. Giant Cholesteatoma: Recommendations for Follow-up. Skull Base. 2008; 18(5):353‐359. doi:10.1055/s-0028-1086054

Diab K.M., Panina O.S., Pashchinina O.A. Modified classification of infralabyrinthie cholesteatoma and scale of cholesteatoma extention. Meditsinskiy sovet = Medical Council. 2020;(16):86-94. (In Russ.) https://doi.org/10.21518/2079-701X-2020-16-86-94

Diab K.M., Panina O.S., Pashchinina O.A. Infralabyrinthine petrous bone cholesteatoma (literature review). Meditsinskiy sovet = Medical Council. 2020;(16):140-149. (In Russ.) https://doi.org/10.21518/2079-701X-2020-16-140-149


Refbacks

Font Size