Surgical treatment of the patients with petrous pyramid cholesteatoma (supralabyrinthine and supralabyrinthine-apical forms)

In this article, the surgical tactics in 13 patients with supralabyrinthine and supralabyrinthine-apical petrous bone cholesteatoma are presented. Petrosectomy was performed by transmastoid approach or in combination with middle fossa approach for the large size — more than 10 mm — tegmental defects repairment. Endoscopic assistance was used during the surgery. In cases of intraoperative cerebrospinal fluid leakage after the removal of cholesteatoma, which spread to internal auditory meatus, trepanation cavity was obliterated with abdominal fat and external auditory channel was closed by ‘’cul-de-sac ‘’technique. In other cases, we performed tympanoplasty with a small tympanic cavity formation. In two cases, we performed the end-to-end plasty of the facial nerve. The minimal period of postoperative follow-up was 1 year. Function of facial nerveе was evaluated at discharge (for 10 days) and 3, 6, 12 months after surgery. The estimation of the reliability of the middle fossa defect repair was carried out according to the CT scan on the 3rd-10th day and 6 months after the surgery. To evaluate the recurrence of cholesteatoma, magnetic resonance imaging in diffuse-weighted mode was done year after the operation. The proposed surgical treatment algorithm allows to achieve a good result with a low rate of cholesteatoma recurrences (15.4%); also, there are no complications revealed related to the auditory and facial nerve function impairment.

Key words: petrous bone cholesteatoma, suppurative otitis media, surgical treatment, middle fossa

Conflicts of interest. The authors have no conflicts of interest to declare.

Funding. There was no funding for this study.