van Dinther Joost J S, Vercruysse Jean-Philippe, De Foer Bert, Somers Thomas, Zarowski Andrzej, Casselman Jan, Offeciers Erwin
University Department of Otolaryngology-Head and Neck Surgery, St Augustinus Hospital, Antwerp, Belgium.
Ann Otol Rhinol Laryngol. 2010 Jan;119(1):42-6. doi: 10.1177/000348941011900108.
Congenital cholesteatomas of the petrosal apex account for 1% to 3% of all cholesteatomas and often present an important surgical challenge. This report describes an exceptional case of a "nondestructive" translabyrinthine surgical approach to a large congenital petrosal cholesteatoma that threatened the vestibulum, superior semicircular canal, facial nerve, and internal auditory canal. We applied a nonconventional transmastoid subarcuate supralabyrinthine approach in a 20-year-old patient by accessing the lesion through the center of the superior semicircular arch without damaging the integrity of the canal. This led to a complete removal of the petrosal cholesteatoma with preservation of hearing and vestibular function. Follow-up imaging performed 1 and 2 years after operation by means of non-echo-planar diffusion-weighted imaging did not show residual cholesteatoma. This report describes the first successful use of a subarcuate supralabyrinthine approach through the arches of the superior semicircular canal in a case of petrosal cholesteatoma.
岩尖先天性胆脂瘤占所有胆脂瘤的1%至3%，常常带来重大的手术挑战。本报告描述了一例罕见病例，采用“非破坏性”经迷路手术方法治疗一个大型先天性岩部胆脂瘤，该胆脂瘤已危及前庭、上半规管、面神经和内耳道。我们对一名20岁患者采用了非传统的经乳突弓下迷路上前方法，通过上半规管弓中心进入病变，而未破坏管道的完整性。这使得岩部胆脂瘤得以完全切除，同时保留了听力和前庭功能。术后1年和2年通过非回波平面扩散加权成像进行的随访影像学检查未显示残留胆脂瘤。本报告描述了在一例岩部胆脂瘤病例中首次成功使用经上半规管弓的弓下迷路上前方法。
