Petrous bone cholesteatoma (PBC): report of 94 cases of PBC with focus on intraoperative endoscopic assistance, and systematic review of the literature.

Abstract

Purpose: The aim of this study is to assess the clinical characteristics, classification, surgical approaches, interventional strategies, and treatment outcomes of patients with petrous bone cholesteatoma (PBC).

Methods: Observational retrospective study of patients with PBC managed by the senior author of this paper between 1995 and 2024 in a tertiary referral center. A literature review was made, identifying 16 articles. Clinical presentations, Sanna's classification, pre- and post-surgical facial function and audiometry, surgical approach and intraoperative endoscopic assistance, postoperative complications, and recurrence rates were reported.

Results: We report on a large series of 94 cases managed by the senior author. The most common type was supralabyrinthine PBCs (40.43%; 38 cases), followed by massive (18.09%; 17). Hearing loss was present in almost all the patients (98.91%). The most frequent approaches were the modified translabyrinthine approach (24.51%; 25), the subtotal petrosectomy (22.55%; 23) and the transotic approach (18.63%; 19). In 11 patients the approach was assisted by the use of an endoscope. Recurrence of PBC was identified in 8 cases (8.51%) that were surgically resolved. Additionally, we report a review of the literature (16 articles).

Conclusions: We focus on the introduction of endoscopic assisted techniques that may help in reducing the rate of residual and avoid rerouting of the facial nerve. At the same time, we encourage techniques that include elimination of the middle ear through a subtotal petrosectomy, as they are essential to protect vital structures that have been exposed by the disease or by the surgical technique.