Warren Frank M, Bennett Marc L, Wiggins Richard H, Saltzman Karen L, Blevins Katherine S, Shelton Clough, Harnsberger H Ric
Division of Otolaryngology, University of Utah, Salt Lake City, Utah, USA.
Laryngoscope. 2007 Aug;117(8):1389-94. doi: 10.1097/MLG.0b013e3180645d50.
Congenital mastoid cholesteatomas are rare lesions of the temporal bone. The clinical presentation of these lesions is variable, making them difficult to identify preoperatively. We evaluated our series of mastoid congenital cholesteatomas (CCs) in an effort to better define the clinical presentation, imaging characteristics, and surgical challenges specific to this lesion.
Retrospective chart and radiologic study review.
The medical records of patients with the diagnosis of mastoid CC on radiologic imaging over a 15-year period were reviewed. All had surgical and pathologic confirmation. Eight patients underwent preoperative computed tomography (CT). Six also underwent magnetic resonance (MR) scanning. Demographic information, clinical presentation, imaging results, and operative findings were recorded.
Nine patients with the diagnosis of mastoid CC satisfying the inclusion criteria were found. Clinical findings were variable, with the most common presentation being an incidental finding. Imaging findings were more uniform. All CT scans demonstrated an expansile, well-circumscribed mass centered within the mastoid portion of the temporal bone. All MR scans showed a well-circumscribed mass with high intensity on T2-weighted images with precontrasted T1 sequences showing the lesion to be isointense or slightly hyperintense to cerebrospinal fluid (CSF). Operative findings included lateral mastoid cortex erosion, sigmoid sinus exposure, ossicular destruction, facial nerve exposure, and associated postauricular abscess. Management of these lesions is reviewed.
Congenital mastoid cholesteatomas have a variable and nonspecific clinical presentation. Surgical challenges arise from the indolent nature of this clinical entity, which belies the extent of otologic involvement. Imaging with CT and magnetic resonance imaging are diagnostic, defines the extent of these lesions, and facilitates preoperative surgical planning.
先天性乳突胆脂瘤是颞骨的罕见病变。这些病变的临床表现多样，术前难以识别。我们评估了一系列乳突先天性胆脂瘤（CCs），以更好地明确该病变的临床表现、影像学特征及手术挑战。
回顾性图表及影像学研究回顾。
回顾了15年间经影像学诊断为乳突CC患者的病历。所有患者均有手术及病理证实。8例患者术前行计算机断层扫描（CT）。6例还进行了磁共振（MR）扫描。记录人口统计学信息、临床表现、影像学结果及手术所见。
发现9例符合纳入标准的乳突CC诊断患者。临床表现多样，最常见的表现为偶然发现。影像学表现更为一致。所有CT扫描均显示颞骨乳突部有一个膨胀性、边界清晰的肿块。所有MR扫描均显示边界清晰的肿块，在T2加权图像上呈高信号，预增强T1序列显示病变与脑脊液（CSF）等信号或略高信号。手术所见包括乳突外侧皮质侵蚀、乙状窦暴露、听骨链破坏、面神经暴露及耳后脓肿。对这些病变的处理进行了回顾。
先天性乳突胆脂瘤临床表现多样且不具特异性。该临床实体的隐匿性导致手术挑战，掩盖了耳科受累程度。CT和磁共振成像有助于诊断、明确病变范围并便于术前手术规划。
