Kumral Tolgar Lütfi, Uyar Yavuz, Yıldırım Güven, Berkiten Güler, Mutlu Ayça Tazegül, Kılıç Mehmet Vefa
Department of Otorhinolaryngology-Head and Neck Surgery, Okmeydanı Training and Research Hospital, Darülaceze Cad. No: 25 Okmeydanı-Şişli, Istanbul, Turkey.
Indian J Otolaryngol Head Neck Surg. 2013 Dec;65(4):327-32. doi: 10.1007/s12070-013-0637-7. Epub 2013 Mar 14.
The aim of this study is to present the clinical symptoms, complications and treatments of the petrous apex cholesteatoma and is to describe the current role of oto-endoscopy. This was a retrospective non-randomized study of 14 petrous apex cholesteatoma surgeries performed between 1994 and 2012. Petrosectomy was performed according to the location of the cholesteatoma, hearing level of the patients and facial nerve function. Oto-endoscopy was used in the petrous apex and the cerebellopontine angle for residual cholesteatoma. 14 patients, seven were men and seven women were included in this study between 1994-2012. The most common symptom was hearing loss (85.7 %) and tinnitus (50 %) at the presentation. During the surgeries, it was observed that cholesteatoma involved most frequently facial nerve, dura and labyrinthines. Labyrinthectomy, middle cranial fossa approach and petromastoidectomy was performed to these patients. Four of six patients operated without the endoscope assistance between 1994-2006 had recurrences after the operation. These patients were re-operated and in the follow up, there was no recurrence. In the endoscopy assisted surgery, there was no recurrence observed (significance level p = 0.014). The most common complication after the surgery was hearing loss (42.8 %) but it was not significant after surgery (p > 0.05). The petrous apex and mastoid cavity was obliterated with fat tissue in eight patients while six patients were exteriorized to follow the recurrence and it was insignificant in recurrences (p > 0.05) CONCLUSION: Endoscope-assisted surgery allows to remove residual the cholesteatoma around the carotid artery, dura and facial nerve in the petrous apex resulting in less invasive surgery and less recurrence in blind spots.
本研究的目的是介绍岩尖胆脂瘤的临床症状、并发症及治疗方法，并描述耳内镜目前的作用。这是一项对1994年至2012年间进行的14例岩尖胆脂瘤手术的回顾性非随机研究。根据胆脂瘤的位置、患者听力水平及面神经功能进行岩骨切除术。耳内镜用于岩尖及桥小脑角检查残余胆脂瘤。1994年至2012年间纳入本研究的14例患者中，男性7例，女性7例。最常见的症状是就诊时听力损失（85.7%）和耳鸣（50%）。手术中观察到胆脂瘤最常累及面神经、硬脑膜和迷路。对这些患者进行了迷路切除术、中颅窝入路和岩乳突切除术。1994年至2006年间6例未在内镜辅助下手术的患者中有4例术后复发。这些患者再次手术，随访中无复发。在内镜辅助手术中，未观察到复发（显著性水平p = 0.014）。术后最常见的并发症是听力损失（42.8%），但术后无显著性差异（p > 0.05）。8例患者用脂肪组织填塞岩尖和乳突腔，6例患者进行外置以观察复发情况，复发情况无显著性差异（p > 0.05） 结论：内镜辅助手术可清除岩尖颈动脉、硬脑膜和面神经周围的残余胆脂瘤，从而减少手术创伤并降低盲点处的复发率。
