Atlas M D, Moffat D A, Hardy D G
Department of Otoneurosurgery, Addenbrooke's Hospital, Cambridge, England.
Laryngoscope. 1992 Dec;102(12 Pt 1):1363-8. doi: 10.1288/00005537-199212000-00010.
The diagnosis and treatment of petrous apex cholesteatoma is a difficult surgical challenge. This study is a review of 14 cases of cholesteatoma involving the petrous apex. These cholesteatomas originated as a congenital primary lesion or secondary to an acquired lesion. The cases were evaluated according to the clinical features, the intraoperative findings, the radiological findings, and the surgical approaches. In this series, 83% of the patients presented with hearing loss and 50% presented with facial nerve weakness or paralysis (House grade II to VI). Intraoperative and radiological features revealed frequent direct labyrinthine and supralabyrinthine cell spread. The transpetrous surgical approach was used in all cases. The main factors affecting the surgical approach to be adopted are the inaccessible nature of the petrous apex, the extent of disease, the degree of facial nerve function, and the need for the prevention of cerebrospinal fluid leaks and the recurrence of the lesion.
岩尖胆脂瘤的诊断与治疗是一项具有挑战性的外科难题。本研究回顾了14例累及岩尖的胆脂瘤病例。这些胆脂瘤起源于先天性原发性病变或继发于后天性病变。根据临床特征、术中发现、影像学表现及手术入路对病例进行评估。在本系列病例中，83%的患者出现听力损失，50%的患者出现面神经无力或麻痹（House分级II至VI级）。术中及影像学特征显示病变常直接向迷路和迷路上细胞蔓延。所有病例均采用经岩骨手术入路。影响手术入路选择的主要因素包括岩尖难以到达的特性、病变范围、面神经功能程度以及预防脑脊液漏和病变复发的必要性。
