Wholly endoscopic permeatal removal of a petrous apex cholesteatoma.

Todd Kanzara,Jagdeep Singh Virk,Sanjiv Chawda,Anthony O Owa

doi:10.1155/2014/184230

Todd Kanzara, Jagdeep Singh Virk + Show 2 more

Open Access

https://doi.org/10.1155/2014/184230

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Abstract

We report a case of a petrous apex cholesteatoma which was managed with a wholly endoscopic permeatal approach. A 63-year-old Caucasian male presented with a 10-year history of right-sided facial palsy and profound deafness. On examination in our clinic, the patient had a grade VI House-Brackmann paresis, otoscopic evidence of attic cholesteatoma behind an intact drum, and extensive scarring of the face from previous facial reanimation surgery. Imaging review was suggestive of petrous apex cholesteatoma. An initial decision to manage the patient conservatively was later reviewed on account of the patient suffering recurrent epileptic seizures. A wholly endoscopic permeatal approach was used with successful outcomes. In addition to the case report we also provide a brief description of the technique and a review of the relevant literature.

Highlights

Petrous bone cholesteatomas are slow growing epidermoid cysts arising from squamous cells in the petrous part of the temporal bone [1, 2]
We present a case of a petrous apex cholesteatoma that was managed using a wholly endoscopic permeatal approach by the senior author
Complete excision is further complicated by the ability of the thin matrix membrane of the cholesteatoma to adhere to other vital structures such as the dura, the internal carotid artery, and the jugular bulb [1, 7]

Summary

Introduction

Petrous bone cholesteatomas are slow growing epidermoid cysts arising from squamous cells in the petrous part of the temporal bone [1, 2]. They can be classified as supralabyrinthine, infralabyrinthine, massive labyrinthine, infralabyrinthine-apical, and apical [1]. A propensity to extend into the petrous apex, skull base, and internal auditory canal is well recognised. These lesions may involve other vital soft tissue structures such as the sigmoid sinus, jugular vein and artery, and the cerebellopontine angle [1, 2]. We present a case of a petrous apex cholesteatoma that was managed using a wholly endoscopic permeatal approach by the senior author

Case Report

Description of Procedure

Discussion

Findings

Conclusion