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Case Reports
. 2016 Mar;77(1):e46-9.
doi: 10.1055/s-0035-1571205.

Giant Petrous Bone Cholesteatoma: Combined Microscopic Surgery and an Adjuvant Endoscopic Approach

Giannicola Iannella  1 , Ersilia Savastano  1 , Benedetta Pasquariello  1 , Massimo Re  2 , Giuseppe Magliulo  1
Affiliations
Case Reports

Giant Petrous Bone Cholesteatoma: Combined Microscopic Surgery and an Adjuvant Endoscopic Approach

Giannicola Iannella et al. J Neurol Surg Rep. 2016 Mar.

Abstract

Petrous bone cholesteatomas (PBCs) are epidermoid cysts, which have developed in the petrous portion of the temporal bone and may be congenital or acquired. Cholesteatomas arising in this region have a tendency to invade bone and functional structures and the middle and posterior fossae reaching an extensive size. Traditionally, surgery of a giant PBC contemplates lateral transtemporal or middle fossa microscopic surgery; however, in recent years, endoscopic surgical techniques (primary or complementary endoscopic approach) are starting to receive a greater consensus for middle ear and mastoid surgeries. We report the rare case of an 83-year-old Caucasian male affected by a giant cholesteatoma that eroded the labyrinth and the posterior fossa dura and extended to the infralabyrinthine region, going beyond the theca and reaching the first cervical vertebra. The giant cholesteatoma was managed through a combined approach (microscopic and, subsequently, complementary endoscopic approach). In this case report, we illustrate some advantages of this surgical choice.

Keywords: endoscopy; giant cholesteatoma; petrous bone cholesteatoma; petrous bone lesions.

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Figures

Fig. 1
Fig. 1
Coronal CT; extensive cholesteatoma eroding part of skull base bone and of the first cervical vertebra (arrow). CT, computed tomography; PBC, petrous bone cholesteatoma.
Fig. 2
Fig. 2
Coronal MRI, T1-weighted sequence; presence of a hyperintense 6 × 2 × 3 cm soft tissue extended between the skull base and the first cervical vertebra. MRI, magnetic resonance imaging; PBC, petrous bone cholesteatoma.
Fig. 3
Fig. 3
Microscopic surgery; residual cholesteatoma adherent to the transverse apophysis of the first cervical vertebra (arrowhead). JG, jugular gulf; PFD, posterior fossa dura.
Fig. 4
Fig. 4
Microscopic view (maximum magnification); residual cholesteatoma adherent to the transverse apophysis of the first cervical vertebra (arrowhead) not entirely visible.
Fig. 5
Fig. 5
Adjuvant endoscopic surgery; delicate dissection of the cholesteatoma matrix adhered to the transverse apophysis of the atlas clearly visible (round knife).
See this image and copyright information in PMC

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