Figure - available from: Case Reports in Otolaryngology
This content is subject to copyright. Terms and conditions apply.
Left ear, pre- ( air conduction and bone conduction) and postoperative ( air conduction and bone conduction) pure-tone audiogram. Hearing thresholds remained on the operated left ear one year after surgery.
Source publication
Objective:
To introduce a novel surgical approach to petrous apex lesion (PA) with superior semicircular canal plugging for hearing preservation. Patient. A 63-year-old patient presented with a recurrent cholesteatoma of the left petrous apex. The patient had a long-term history of cholesteatoma and MRI with diffusion-weighted imaging (DWI) detect...
Similar publications
Citations
... Cholesterol granulomas encompass the most frequent destructive lesion of the petrous apex. 1 Cholesterol granulomas form when the aeration of the petrous apex is hindered, thus creating a vacuum into which blood is drawn, causing foreign body giant cell reaction to cholesterol deposits, with fibrosis. 2 They are ten times more common than cholesteatomas and forty times more common than petrous apex mucoceles. ...
... Each of the surgical approaches offers a unique set of benefits, and some can predispose to complications more than others [ Table 2]. [1,2,5,6,15,20,31,32,36] In certain instances, mastoidectomy is indicated in order to achieve maximal resection. For example, the canal-wall down (CWD) open mastoidectomy approach involves removal of the posterior semicircular canal which can afford superior visualization of the diseased middle ear anatomy. ...
... Most direct route to petrous apex, [15,36] approach of choice in patients with a high jugular bulb or anterior sigmoid sinus, wider exposure of anterior, medial, and median cerebellopontine angle [6,20] Unsuited for hearing preservation in most cases, high risk of damage to vestibular and cochlear organs [6] Infralabyrinthine Approach of choice in patients with severe hearing loss or deafness [2] May result in conductive hearing loss [2] Infracochlear (meatal) Preserves hearing function in most cases, may be accessed via endoscopic techniques [20] May result in conductive hearing loss [20] Middle cranial fossa Recommended approach for isolated congenital petrous apex cholesteatomas and hearing preservation [1,5] CSF leak (in up to 13% of patients), facial nerve palsy, meningitis, hydrocephalus, ataxia, more limited access, limited exposure to petrous apex and may lead to a secondary surgery [1] ...
Background: Cholesteatomas are growths of squamous epithelium that can form inside the middle ear and mastoid cavity and damage nearby structures causing hearing loss when located at the petrous apex. The primary goal of petrous apex cholesteatoma resection is gross total removal with tympanoplasty and canal-wall up or canal-wall down tympanomastoidectomy. At present, there is no definitive surgical approach supported by greater than level 4 evidence in the literature to date.
Methods: A systematic review was conducted utilizing PubMed, Embase, and Scopus databases. Articles were screened and selected to be reviewed in full text. The articles that met inclusion criteria were reviewed for relevant data. Data analysis, means, and standard deviations were calculated using Microsoft Excel.
Results: After screening, five articles were included in the systematic review. There were a total of eight pediatric patients with nine total cholesteatomas removed. Conductive hearing loss was the most common (77%) presenting symptom. Perforations were noted in seven ears (86%). Recurrence was noted in 50% of patients with an average recurrence rate of 3.5 years (SD = 1.73). Average length of follow-up was 32.6 months (SD = 21.7). Canal-wall up was the most utilized technique (60%) and there were zero noted surgical complications. Five of the seven (71%) patients that experienced hearing loss from perforation noted improved hearing.
Conclusion: Due to its rarity, diagnostic evaluation and treatment can vary. Further, multi-institutional investigation is necessary to develop population-level management protocols for pediatric patients affected by petrous apex cholesteatomas.
Congenital cholesteatoma is rare, and especially so for a benign mass to grow from the squamous epithelium and the petrous apex as a location for this cancer. Surgery of the petrous apex cholesteatoma is challenging due to the location of the lesion and the need to preserve adjacent structures such as the dura mater, internal carotid artery, and internal auditory canal. Imaging studies, including CT and MRI, were crucial in guiding the surgical approach. This report describes a 40-year-old male patient with a large congenital cholesteatoma involving the petrous apex and temporal bone. The patient presented with a headache, hearing loss that persisted despite prior medical treatment. The cholesteatoma was surgically marsupialized through translabyrinthine approach, and the patient has remained stable for over 20 years. This report underscores the importance of considering the anatomical location and relationships of the lesion and adjacent structures when determining the surgical approach for congenital cholesteatoma involving the petrous apex and temporal bone.
Petrous apex cholesteatoma is a relatively rare and chronic aggressive disease that occurs in the petrous part of the temporal bone and can be classified as congenital or acquired. Due to the tendency of petrous cholesteatomas to cause bone destruction and invade important structures such as the facial nerve, cochlea, and semicircular canal, patients present mainly with severe hearing loss, progressive peripheral facial palsy, vertigo, etc. When the lesion invades the intracranial region or is infected, intracranial symptoms such as meningitis, lateral sinus thrombosis, and brain abscess may be present. We report a case of giant petrous cholesteatoma with Pseudomonas aeruginosa infection, with the aim of exploring the corresponding clinical treatment and surgical modalities to provide a reference for the clinical management of this type of disease.
