Diagnosis and surgical management of petrous apex cholesteatoma

Objective: To explore the etiology, diagnosis and surgical management of petrous apex cholesteatoma.

Methods: Twelve cases of petrous apex cholesteatoma (primary 3, secondary 9) were retrospectively studied.

Results: Primary petrous apex cholesteatoma was characterized by non otorrhea history, normal tympanic membrane appearance and the initially occurring symptoms of facial paralysis and hearing loss. In contrast, secondary petrous apex cholesteatoma was characterized by otitis media history, perforated drum, hearing loss and facial paralysis. The treatment principle for either primary or secondary cholesteatoma is to remove all the cholesteatoma. Based on the status of hearing and location and extent of cholesteatoma within temporal bone, 4 surgical approaches were taken in our study, which were translabyrinth, middle cranial fossa, combination of translabyrinth and middle cranial fossa, craniocervical combination approach (intralabyrinth approach). The complications of these surgical procedures and their management were discussed. According to result of 4 months to 15 years follow-up, there were no recurrence cases up to now, except one, which was operated 4 times as recurrence. Facial nerve anastomosis (3/12) or decompression (3/12) was performed simultaneously in the operations. The function of facial nerve partially recovered from V to IV of House and Brackmann grading in 2 out of 3 anastomosis cases and from IV to III in 2 out of 3 cases of decompression.

Conclusions: Although there are some differences in symptoms and etiology between primary and secondary petrous apex cholesteatoma, complete surgical removal of lesion is necessary for both. Surgical approaches are decided according to location and extent of the lesion and hearing status. Our study indicated that open cavity operation had more advantage in terms of morbidity compared with the closed cavity operation, which closes the auditory canal as a blind sac.