University Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern, Switzerland.
Otol Neurotol. 2011 Feb;32(2):236-41. doi: 10.1097/MAO.0b013e3182001ef4.
Clinical and radiologic outcome analysis after petrous bone cholesteatoma (PBC) removal with simultaneous functional reconstruction.
Retrospective case review over an observation period of 16 years (1992-2007).
Tertiary referral center.
A total of 21 patients (17 adults and 4 children) with PBCs were included, accounting for 3.4% of all cholesteatoma cases (n = 621). The average follow-up duration was 7 years (range, 2-15 yr). In all patients, a modified subtotal petrosectomy was performed with simultaneous tympanoplasty, musculoplasty, and meatoplasty in 90%. In 2 patients (10%), the cavity was obliterated. Two others (10%) needed a simultaneous temporal craniotomy.
Preoperative, intraoperative, and postoperative findings including signs, classifications, recurrences, hearing, and facial nerve outcomes.
In the majority of patients (67%), a supralabyrinthine PBC was found. Complete macroscopic resection was achieved in all patients. During the follow-up period, 4 patients (19%) were identified as having recurrent disease. Hearing was postoperatively preserved in 14 of 17 patients with preoperative hearing (82%; 4 preoperative dead ears), of whom, 13 had functional hearing, with a mean pure-tone average of 37 dB (range, 15-55 dB). Preoperative facial nerve dysfunction completely resolved in 4 of 6 patients, and no new dysfunctions occurred postoperatively. All cavities became self-cleaning and dry.
Hearing preservation was feasible in the majority of patients with PBCs. The functional surgical concept and the high number of supralabyrinthine lesions seemed to be important prerequisites for the good functional outcomes observed.
分析同时进行功能重建的岩骨胆脂瘤（PBC）切除术后的临床和放射学结果。
回顾性病例研究，观察期为 16 年（1992-2007 年）。
三级转诊中心。
共纳入 21 例（17 例成人和 4 例儿童）PBC 患者，占所有胆脂瘤病例的 3.4%（n=621）。平均随访时间为 7 年（范围，2-15 年）。所有患者均行改良次全岩骨切除术，同时行鼓室成形术、肌肉成形术和肉柱成形术，占 90%。2 例（10%）患者行鼓室腔填塞术，2 例（10%）患者需同期行颞骨切开术。
术前、术中及术后发现，包括体征、分类、复发、听力及面神经结果。
大多数患者（67%）为上鼓室胆脂瘤。所有患者均达到完全的肉眼肿瘤切除。在随访期间，4 例（19%）患者被发现有复发病例。17 例术前有听力的患者中有 14 例（82%；4 例术前为聋耳）术后听力得以保留，其中 13 例有功能性听力，平均纯音平均听力值为 37 dB（范围，15-55 dB）。6 例术前面神经功能障碍的患者中有 4 例（67%）完全缓解，术后无新的面神经功能障碍发生。所有鼓室腔均自行清洁干燥。
大多数 PBC 患者可实现听力保留。功能外科理念和较高比例的上鼓室病变似乎是观察到良好功能结果的重要前提。
