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Sharma V, K. ND, Tiwari S, Soni K, Khera P, Goyal A. Petrous Bone Cholesteatoma- A Comprehensive Management Algorithm and Outcomes. Indian J Otolaryngol Head Neck Surg 2025; 77:6-12. [PMID: 40071011 PMCID: PMC11890895 DOI: 10.1007/s12070-024-05052-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 08/22/2024] [Indexed: 03/14/2025] Open
Abstract
Background: Petrous bone cholesteatoma (PBC) is a challenging condition involving the development of an epidermoid cyst within the petrous portion of the temporal bone. Advances in radiological imaging and skull base surgery have refined the management of PBC. Methods: An ambispective descriptive study was conducted on patients diagnosed with PBC between 2021 and 2024. Clinical and audiological evaluations were performed, and radiological imaging was utilized to assess disease extent. Surgical approaches were chosen based on cholesteatoma location and functional impairment. Postoperative outcomes, including complications and recurrence, were documented, and patients underwent regular follow-ups. Results: Ten patients with PBC were included in the study, majority of the cases were acquired cholesteatoma (8/10). Hearing loss was the most common presenting symptom and 3 patients had facial palsy at the time of presentation. Radiological features like carotid canal erosion and jugular bulb erosion were also evident in PBC. Surgical interventions included subtotal petrosectomy and radical mastoidectomy. Additional use of endoscopy ensured complete removal of cholesteatoma matrix. Postoperatively, improvements in facial nerve function were observed, with no recurrence noted during follow-up. Conclusion: Tailoring PBC management involves assessing lesion location, extent, and functional outcomes. Extensive disease may require aggressive surgical techniques, prioritizing hearing and facial nerve preservation. The endoscopic transsphenoidal approach is promising for petrous apex involvement, with benefits in morbidity and recovery. Vigilant postoperative monitoring is crucial for complication detection and long-term remission assurance. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-024-05052-5.
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Affiliation(s)
- Vidhu Sharma
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur Mobile No: + 91, Jodhpur, 8547956262 India
| | - Nidhin Das K.
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur Mobile No: + 91, Jodhpur, 8547956262 India
| | - Sarbesh Tiwari
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Kapil Soni
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur Mobile No: + 91, Jodhpur, 8547956262 India
| | - Pushpinder Khera
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Amit Goyal
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur Mobile No: + 91, Jodhpur, 8547956262 India
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Li KL, Agarwal V, Moskowitz HS, Abuzeid WM. Surgical approaches to the petrous apex. World J Otorhinolaryngol Head Neck Surg 2020; 6:106-114. [PMID: 32596655 PMCID: PMC7296478 DOI: 10.1016/j.wjorl.2019.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 11/27/2019] [Indexed: 11/18/2022] Open
Abstract
The petrous apex is a difficult to reach surgical area due to its deep position in the skull base and many vital surrounding structures. Petrous apex pathology ranges from extradural cholesterol granulomas, cholesteatomas, asymmetric pneumatization, and osteomyelitis to intradural meningiomas and schwannomas. Certain lesions, such as cholesterol granulomas, can be managed with drainage while neoplastic lesions must be completely resected. Surgical options use open, endoscopic, and combined techniques and are categorized into anterior, lateral, and posterior approaches. The choice of approach is determined by the nature of the pathology and location relative to vital structures and extension into surrounding structures and requires thorough preoperative evaluation and discussion of surgical goals with the patient. The purpose of this state-of-the-art review is to discuss the most commonly used surgical approaches to the petrous apex, and the anatomy on which these approaches are based.
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Affiliation(s)
- Kevin L Li
- Department of Otorhinolaryngology - Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Vijay Agarwal
- Department of Neurosurgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Howard S Moskowitz
- Department of Otorhinolaryngology - Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Waleed M Abuzeid
- Department of Otorhinolaryngology - Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
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Al Zaabi K, Hassannia F, Bergin MJ, Rutka JA. Management of invasive intralabyrinthine cholesteatoma: Can one realistically preserve hearing when disease is medial to the otic capsule? Am J Otolaryngol 2020; 41:102407. [PMID: 32014300 DOI: 10.1016/j.amjoto.2020.102407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/21/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE To report our long-term results in surgical management of invasive intralabyrinthine cholesteatoma. MATERIAL AND METHODS The study is a case series in a tertiary referral center. Retrospective chart review of all mastoid operations performed for chronic ear disease between 1994 and 2019 at University Health Network, Toronto. The type of surgery, intraoperative findings, hearing outcome, recurrence of disease and the need for revision surgery were evaluated. RESULTS 10 cases of extensive petrous bone cholesteatoma medial to the otic capsule were identified in 616 mastoid surgeries. All but one patient with extensive petrous bone cholesteatoma who underwent an exteriorizing procedure to preserve cochlear function failed the first surgery. A second procedure was needed in all cases due to complications which included facial palsy, recurrent cholesteatoma or internal auditory canal (IAC) abscess. Hearing was not preserved in any patient. In contrast, 57 ears with cholesteatomatous labyrinthine fistula lateral to the otic capsule had matrix exteriorized and had very good long-term results. CONCLUSION We were rarely able to preserve hearing in massive petrous bone cholesteatoma. There should be no hesitation to remove the otic capsule to exteriorize diseases even under circumstances where residual cochlear and vestibular function is present if required to provide a safe ear.
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Choi KJ, Jang DW, Zomorodi AR, Codd PJ, Friedman A, Abi Hachem R. Novel Application of Steroid Eluting Stent in Petrous Apex Cholesterol Granuloma. J Neurol Surg B Skull Base 2019; 80:500-504. [PMID: 31534892 DOI: 10.1055/s-0038-1675751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 10/06/2018] [Indexed: 10/27/2022] Open
Abstract
Objective This study describes the safety and efficacy of mometasone furoate eluting stents in the management of petrous apex cholesterol granuloma approached through an endonasal endoscopic route and assesses the restenosis rate. Methods Consecutive patients undergoing endoscopic endonasal marsupialization of a petrous apex cholesterol granuloma at a tertiary referral center who had a mometasone furoate eluting stent placed intraoperatively were reviewed in a retrospective fashion. Postoperative endoscopy was used to determine success of surgery and stenting. Results Five patients were included in the study, three were primary cases and two patients had revision surgeries performed. The steroid eluting stent was placed successfully and safely in all patients with no dural or vascular injuries. The average follow-up duration was 10.6 months. There was no restenosis in three patients and one patient had an immediate restenosis that was debrided in clinic (revision case). This was patent at the 16 months follow-up. One patient also developed stenosis, 4 months after surgery due to sphenoid sinusitis. Conclusion Mometasone furoate eluting stents are safe and effective in the primary management of petrous apex cholesterol granuloma. Further studies are needed to assess their efficacy in revision cases and for long term results.
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Affiliation(s)
- Kevin J Choi
- Division of Head and Neck Surgery and Communication Sciences, Department of Surgery, Duke University, Durham, North Carolina, United States
| | - David W Jang
- Division of Head and Neck Surgery and Communication Sciences, Department of Surgery, Duke University, Durham, North Carolina, United States.,Department of Neurosurgery, Duke University, Durham, North Carolina, United States
| | - Ali R Zomorodi
- Department of Neurosurgery, Duke University, Durham, North Carolina, United States
| | - Patrick J Codd
- Department of Neurosurgery, Duke University, Durham, North Carolina, United States
| | - Allan Friedman
- Department of Neurosurgery, Duke University, Durham, North Carolina, United States
| | - Ralph Abi Hachem
- Division of Head and Neck Surgery and Communication Sciences, Department of Surgery, Duke University, Durham, North Carolina, United States.,Department of Neurosurgery, Duke University, Durham, North Carolina, United States
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Sharma SC, Panda S, Thakar A, Devaraja K. Petrous Bone Cholesteatoma: Radical Excision with an Endeavour for Hearing Preservation. Indian J Otolaryngol Head Neck Surg 2019; 71:1572-1579. [PMID: 31750219 DOI: 10.1007/s12070-019-01662-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 04/20/2019] [Indexed: 11/27/2022] Open
Abstract
To describe surgical outcomes following resection of giant petrous bone cholesteatoma. Retrospective cohort study was undertaken at a tertiary care centre on patients who had undergone surgery for petrous bone cholesteatoma (PBC) from August 2014 to September 2017. For patients with serviceable hearing preoperatively, labyrinth preserving techniques, namely, modified transmastoid translabyrinthine approach (massive PBC-1) and supralabyrinthine approach (supralabyrinthine PBC-1) were considered. In the former, bony labyrinth which had been destroyed due to the disease process, membranous labyrinth remained anatomically and functionally intact following meticulous dissection to remove cholesteatoma matrix. In the latter, supralabyrinthine cell tracts were exenterated without disturbing the cochlea and labyrinth with a canal wall down mastoidectomy. For the remaining patients, labyrinth ablative approach was undertaken (translabyrinthine/transotic). Facial nerve function was evaluated using House-Brackman grading system. Hearing was evaluated using pure tone audiometry. 7 patients were identified (massive-2, supralabyrinthine-3, supralabyrinthine apical-1, infralabyrinthine apical 1). None of the patients experienced deterioration of postoperative bone conduction or facial nerve function (preop-grade 5-4, grade 6-3; postop-grade 2-1, grade 3-2, grade 4-4). Facial nerve was decompressed and anatomically intact in 3 cases. In the remaining, facial hypoglossal anastomosis was done in 3 and facial masseteric anastomosis was done in 1 patient. With a median follow-up of 26 months, recurrence in the form of keratin pearl was seen in 1 patient. Modified translabyrinthine approach preserving membranous labyrinth is a promising hearing preservation strategy.
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Affiliation(s)
- Suresh C Sharma
- 1Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Teaching Block, 4th Floor, AIIMS, Ansari Nagar, East, New Delhi, 110029 India
| | - Smriti Panda
- 1Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Teaching Block, 4th Floor, AIIMS, Ansari Nagar, East, New Delhi, 110029 India
| | - Alok Thakar
- 1Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Teaching Block, 4th Floor, AIIMS, Ansari Nagar, East, New Delhi, 110029 India
| | - K Devaraja
- 2Department of Otolaryngology and Head and Neck Surgery, Kasturba Medical College, Mangalore, India
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Endoscopic Endonasal Approach to Selected Lesions of the Petrous Apex. CURRENT OTORHINOLARYNGOLOGY REPORTS 2019. [DOI: 10.1007/s40136-019-00228-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Patron V, Humbert M, Micault E, Emery E, Hitier M. How to perform microscopic/endoscopic resection of large petrous apex lesions. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:443-447. [PMID: 29934262 DOI: 10.1016/j.anorl.2018.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The endoscope and microscope can be used conjointly in certain sites, such as middle ear cholesteatoma or for resection of cerebellopontine angle tumours. Petrous apex tumours are classically accessed via a lateral otological approach, or, for the most anterior tumours, via an endonasal endoscopic approach. Surgical access via a lateral incision is limited inferiorly by the superior bulb of the internal jugular vein, medially by the labyrinth, facial nerve and internal auditory canal, superiorly by the dura mater, and laterally by the internal carotid artery. Via an anterior endonasal approach, the corridor formed by the internal carotid artery and the paraclival dura limits access to the posterior part of the petrous apex, restricting this approach to certain cholesterol granulomas or small cholesteatomas. None of these approaches, on its own, is sufficient in the case of an extensive petrous apex lesion. The objective of this technical note is to describe the combined microscopic/endoscopic approach comprising sequential use of the microscope and the endoscope via a lateral approach for the management of large petrous apex lesions.
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Affiliation(s)
- V Patron
- Service d'ORL et de chirurgie cervico-faciale, CHU de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France.
| | - M Humbert
- Service d'ORL et de chirurgie cervico-faciale, CHU de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - E Micault
- Service d'ORL et de chirurgie cervico-faciale, CHU de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - E Emery
- Service de Neurochirurgie, CHU de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France; UniCaen, UFR de médecine, 14000 Caen, France
| | - M Hitier
- Service d'ORL et de chirurgie cervico-faciale, CHU de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France; UniCaen, UFR de médecine, 14000 Caen, France
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Prasad SC, Piras G, Piccirillo E, Taibah A, Russo A, He J, Sanna M. Surgical Strategy and Facial Nerve Outcomes in Petrous Bone Cholesteatoma. Audiol Neurootol 2016; 21:275-285. [DOI: 10.1159/000448584] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 07/20/2016] [Indexed: 11/19/2022] Open
Abstract
Objective: To review the classification and management of petrous bone cholesteatomas (PBCs) at our center and the outcomes of facial nerve (FN) management in these lesions. Methods: This was a retrospective study. The setting was a quaternary referral center for skull base pathology in Italy. A total of 200 patients with 201 PBCs were included in the study. All patients diagnosed radiologically with PBCs were classified according to the Sanna classification. All patients were surgically treated and followed up with radiology. The main outcome measures - classification of PBCs, the surgical approach used, disease control, and FN outcomes - were analyzed. Results: Supralabyrinthine PBCs were the most common type with 92 cases (45.8%) followed by the massive PBCs with 72 cases (35.8%). Preservation of preoperative FN function was highest in the infralabyrinthine (72.2%) and infralabyrinthine-apical (73.3%) types. The transotic approach was used in 66 cases (32.8%) in this series. The modified transcochlear approach type A was applied in 55 cases (27.3%). Active management of the nerve (rerouting, anastomosis, or grafting) was required in 53 cases (26.4%). Postoperatively, of the 116 cases with FN House-Brackmann grade I and II, 107 cases (92.2%) retained the same grade or improved. Recurrence was seen in 7 cases (3.5%). The mean duration of follow-up was 6.3 years. Conclusions: Radical disease clearance must take precedence over hearing and FN preservation in PBCs. Active FN management, including rerouting, end-to-end anastomosis, and cable nerve grafting, routinely come to play in the surgical management of PBCs, and the postoperative FN results after such interventions can be satisfactory in most cases.
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Kanona H, Virk JS, Owa A. Endoscopic ear surgery: A case series and first United Kingdom experience. World J Clin Cases 2015; 3:310-317. [PMID: 25789304 PMCID: PMC4360503 DOI: 10.12998/wjcc.v3.i3.310] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 12/17/2014] [Accepted: 01/19/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To present the United Kingdom’s first case series of 70 otological cases of endoscopic and non-endoscopic ear surgeries.
METHODS: Prospective case series incorporating a range of endoscopic procedures performed using a 4 mm, 18 cm rigid endoscope, performed by a single surgeon at a single centre. Primary outcome measures included mean average pre and post-operative air-bone gap hearing thresholds and duration of surgery.
RESULTS: Thirty-eight patients underwent endoscopic assisted ear surgery and 32 underwent non-endoscopic assisted ear surgery. In both surgical groups, there was a significant difference between pre and post-operative mean air-bone gaps (P = 0.02). Mean operating time was comparable between both groups. Eight patients developed post-operative complications.
CONCLUSION: Endoscopic ear surgery can be performed safely in a range of otological procedures. This has the potential to become a well-established surgical option for middle ear surgery in the near future. Advantages and limitations are discussed.
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Kumral TL, Uyar Y, Yıldırım G, Berkiten G, Mutlu AT, Kılıç MV. Does endoscopic surgery reduce recurrence of the petrous apex cholesteatoma? Indian J Otolaryngol Head Neck Surg 2013; 65:327-32. [PMID: 24427593 DOI: 10.1007/s12070-013-0637-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 03/04/2013] [Indexed: 11/25/2022] Open
Abstract
The aim of this study is to present the clinical symptoms, complications and treatments of the petrous apex cholesteatoma and is to describe the current role of oto-endoscopy. This was a retrospective non-randomized study of 14 petrous apex cholesteatoma surgeries performed between 1994 and 2012. Petrosectomy was performed according to the location of the cholesteatoma, hearing level of the patients and facial nerve function. Oto-endoscopy was used in the petrous apex and the cerebellopontine angle for residual cholesteatoma. 14 patients, seven were men and seven women were included in this study between 1994-2012. The most common symptom was hearing loss (85.7 %) and tinnitus (50 %) at the presentation. During the surgeries, it was observed that cholesteatoma involved most frequently facial nerve, dura and labyrinthines. Labyrinthectomy, middle cranial fossa approach and petromastoidectomy was performed to these patients. Four of six patients operated without the endoscope assistance between 1994-2006 had recurrences after the operation. These patients were re-operated and in the follow up, there was no recurrence. In the endoscopy assisted surgery, there was no recurrence observed (significance level p = 0.014). The most common complication after the surgery was hearing loss (42.8 %) but it was not significant after surgery (p > 0.05). The petrous apex and mastoid cavity was obliterated with fat tissue in eight patients while six patients were exteriorized to follow the recurrence and it was insignificant in recurrences (p > 0.05) CONCLUSION: Endoscope-assisted surgery allows to remove residual the cholesteatoma around the carotid artery, dura and facial nerve in the petrous apex resulting in less invasive surgery and less recurrence in blind spots.
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Affiliation(s)
- Tolgar Lütfi Kumral
- Department of Otorhinolaryngology-Head and Neck Surgery, Okmeydanı Training and Research Hospital, Darülaceze Cad. No: 25 Okmeydanı-Şişli, Istanbul, Turkey
| | - Yavuz Uyar
- Department of Otorhinolaryngology-Head and Neck Surgery, Okmeydanı Training and Research Hospital, Darülaceze Cad. No: 25 Okmeydanı-Şişli, Istanbul, Turkey
| | - Güven Yıldırım
- Department of Otorhinolaryngology-Head and Neck Surgery, Okmeydanı Training and Research Hospital, Darülaceze Cad. No: 25 Okmeydanı-Şişli, Istanbul, Turkey
| | - Güler Berkiten
- Department of Otorhinolaryngology-Head and Neck Surgery, Okmeydanı Training and Research Hospital, Darülaceze Cad. No: 25 Okmeydanı-Şişli, Istanbul, Turkey
| | - Ayça Tazegül Mutlu
- Department of Otorhinolaryngology-Head and Neck Surgery, Okmeydanı Training and Research Hospital, Darülaceze Cad. No: 25 Okmeydanı-Şişli, Istanbul, Turkey
| | - Mehmet Vefa Kılıç
- Department of Otorhinolaryngology-Head and Neck Surgery, Okmeydanı Training and Research Hospital, Darülaceze Cad. No: 25 Okmeydanı-Şişli, Istanbul, Turkey
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Shoman N, Donaldson AM, Ksiazek J, Pensak ML, Zimmer LA. First stage in predicative measure for transnasal transsphenoidal approach to petrous apex cholesterol granuloma. Laryngoscope 2013; 123:581-3. [PMID: 23404633 DOI: 10.1002/lary.23754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 08/10/2012] [Accepted: 08/23/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study evaluates the feasibility of the transsphenoidal approach to petrous apex cholesterol granuloma based on the petrous angle. This is the angle centered at the vomer, extending between the medial aspect of the C3 segment of the internal carotid artery and the occipital protuberance. The aim of this study is to determine the average petrous angle in a population of normal computed tomography scans. STUDY DESIGN Retrospective review at the University of Cincinnati Medical Center. METHODS Two of the authors independently reviewed 400 consecutive normal temporal bone computed tomography scans obtained between September and December of 2009. All scans had slice thickness of 1.25 mm at 0.6-mm intervals. Axial images parallel to the orbitomeatal plane were analyzed, and the petrous angle was measured bilaterally. Interrater reliability was tested on 50 of the computed tomography scans. RESULTS A total of 400 temporal bones were reviewed. The mean and median petrous angle was 17.7 and 16.5 degrees, respectively. Eleven (2.8%) had an angle ≤ 10.0, 331 (82.8%) between 10.1 to 20.0, and 58 (14.5%) ≥ 20.1. The interrater variability was highly correlated (r = 0.912, P < .005). CONCLUSIONS Normative data on consistent petrous apex radiographic landmarks are important for assessing the feasibility of the transphenoidal approach to the petrous apex for cholesterol granuloma drainage. Based on a large population of normal computed tomography scans, the majority of temporal bones (82.8%) have a petrous angle ranging between 10.0 and 20.0 degrees.
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Affiliation(s)
- Neal Shoman
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati Academic Health Center, Cincinnati, Ohio 45267-0528, USA
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Emanuelli E, Ciorba A, Bianchini C, Bossolesi P, Stomeo F, Pelucchi S. Transnasal endoscopic management of petrous apex and clivus selected lesions. Eur Arch Otorhinolaryngol 2012; 270:1747-50. [PMID: 23100083 DOI: 10.1007/s00405-012-2229-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 10/11/2012] [Indexed: 11/29/2022]
Abstract
The objective of this study was to report a series of selected primary skull base benign lesions midline located by transnasal endoscopic transsphenoidal approach. A retrospective review of 5 cases is presented: four cholesterol granuloma of the petruos apex and one of the clivus. All patients have been successfully treated via transnasal endoscopic transsphenoidal approach. The mean duration of follow-up was 27 months (range 12-50 months). No postoperative complication such as CSF leak, meningitis, or encephalocele and no signs of recurrence have been noticed. The transnasal route is a minimally invasive, safe, and efficient technique to approach the petrous apex and clivus for selected midline skull base lesions removal.
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Affiliation(s)
- E Emanuelli
- ENT and Otosurgery Department, University Hospital of Padua, Padua, Italy
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