Our Endoscopic Strategy and Experiences in Management of The Complex Petrous Bone and Lateral Skull Base Cholesteatoma

By June 7, 2019

Zhaohui, Hou1
1 Department of Otolaryngology – Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China.

We share our Endoscopic strategy and experiences in management of complex petrous bone and lateral skull base cholesteatoma.

– Study Design:  retrospective case review.
– Setting: PLA genaral hospital.
– Patients: Based on the Sanna’s Classification of petrous bone of Cholesteatoma, we selected seven classical cases of petrous bone cholesteatoma with different extension to Clivus, Sphenoid sinus and / or Rhinopharynx space.
– Intervention(s): Depending on the lesion’s location, size, hearing function level, facial nerve function, we chosen middle fossa approach、 transotic approach, retrolabyrinthine or infralabyrinthine approach, with combination with Endoscope,   the lesions could be removed completely without disruption of facial nerve by rerouting.

– Main Outcome Measure(s): The DWI image was used as the main tool to follow up all cases.  And facial function was evaluated before and after operation sysmatically.
– Results:the lesion with type of supralabyrinthine, infralabyrinthine, infralabyrinthine-apical, massive and apical by Sanna’s Classification could be handled successfully and these patients’facial nerve function were successfully protected, with perfect results after long term follow-up. While when the lesions extend to lateral skull base extensively, especially near the middle line structures, routine strategies for petrous bone Cholesteatoma could not work and even have high likelihood of CSF leak and intracranial infection. We involved some special surgical strategies to deal with the tricky case and get good result finally.
– Conclusion:We valued the role of Endoscope played in the strategy of complex petrous bone and skull base cholesteatoma, which helps removing hiding lesions and lowing the complication, preserving the facial function as much as we could.