gms | German Medical Science

Introduction: Petrous bone is one of the most complex bone of the human body. Though cholesteatoma only account for 4-9% of all petrous pyramid lesions, it is one of the most complex lesion with difficulty in diagnosis and treatment. There were many different classification systems and surgical approaches of petrous bone cholesteatoma. Our team combined microscopic and endoscopic approaches and made comparison between them.

Methods: Six patients of petrous bone cholesteatoma underwent surgical treatment in our department. Three of them underwent microscopic infratemporal fossa approach Type B, while the other three underwent endoscopic transmasotid approach.

Results: All six cases got their petrous bone cholesteatoma completely removed and no relapse in the follow-up till now. The cholesteatomas of all three microscopic case had a close relationship with internal carotid artery, which had to be relocated or skeletonized in the surgery. The cholesteatomas of all three endoscopic cases were located in the medial and superior to the labyrinth and had no close relationship with internal carotid artery. Besides, the endoscopic cases achieved the preservation of the otic capsule.

Conclusion: Although there are still some controversies about the classification of petrous bone cholesteatoma, we hold the opinion that the surgical approach should be determined upon the location of the lesion. The aim of surgery should be radical exenteration and function preservation, and radical exenteration of takes priority over function preservation. Precisely mapping the lesion and demonstrating the relationships to the involving neural and vascular structures guarantee surgeons to plan approaches maximizing the chance for resection while minimizing morbidity.

Unterstützt durch: Peking Union Medical College Hospital

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