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Case Reports
. 2021 Jul;17(4):368-371.
doi: 10.5152/iao.2021.9153.

Exteriorization of Petrous Bone Cholesteatoma by Endonasal Endoscopic Approach: A Case Report

Naoya Nishida  1 , Takuya Fujiwara  2 , Suehiro Satoshi  3 , Akira Inoue  3 , Daiki Takagi  4 , Taro Takagi  1 , Naohito Hato  1
Affiliations
Case Reports

Exteriorization of Petrous Bone Cholesteatoma by Endonasal Endoscopic Approach: A Case Report

Naoya Nishida et al. J Int Adv Otol. 2021 Jul.

Abstract

A 61-year-old woman presented with diplopia and headache. The patient had a longstanding history of petrous bone cholesteatoma (PBC) on the left side and had undergone multiple surgeries to address it. Computed tomography (CT) revealed a radiolucent lesion with bony destruction in the left petrous apex. Magnetic resonance imaging of the lesion revealed a hypointense area on T1-weighted images and a hyperintense area on T2-weighted and abnormal diffusion-weighted images. A diagnosis of recurrent petrous apex cholesteatoma was made. The patient was treated by exteriorization using an endoscopic endonasal approach. The patient is in remission and doing well. The ideal treatment of PBC is complete excision, though exteriorization using an endoscopic endonasal approach is considered a second option when excision is not possible.

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Conflict of interest statement

Conflict of Interest: The authors have no conflict of interest to declare.

Figures

Figure 1.
Figure 1.
Preoperative computed tomography. A destructive lesion involves the bone at the petrous apex, and the body is aerated. There is a bony defect in the posterior wall of the left sphenoidal sinus.
Figure 2.
Figure 2.
(A) Preoperative computed tomography. The petrous apex filled with the shadow of a soft tissue lesion. (B) Hyperintense lesion on T2-weighted magnetic resonance imaging. (C) Hyperintense lesion on diffusion-weighted magnetic resonance imaging.
Figure 3.
Figure 3.
Intraoperative findings: (A) A wide bilateral sphenoidotomy with removal of the rostrum and the intersinus septum (white arrow head) was performed. The matrix (white arrow) is exposed on the posterior wall of the left sphenoidal sinus. (B) The site after matrix (black asterisk) removal. (C) The exposed bony window of the fenestration was covered with a nasoseptal mucosal flap (white asterisk).
Figure 4.
Figure 4.
Postoperative computed tomography. The petrous apex is aerated and patent with the sphenoidal sinus.
See this image and copyright information in PMC

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