Bruchhage Karl-Ludwig, Wollenberg Barbara, Leichtle Anke
Department of Otolaryngology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
Eur Arch Otorhinolaryngol. 2017 Jul;274(7):2749-2756. doi: 10.1007/s00405-017-4593-9. Epub 2017 May 4.
Space-demanding or destructive changes in the petrous bone are often challenging differential diagnosis. Cholesterol granulomas of the petrous apex can clinically present in a combination of hearing loss, vertigo, tinnitus, chronic cephalgia, impairment of facial nerve function, neuralgic pain of the nervus trigeminus, or manifest diplopia by the nerve palsy of the nervus abducens. CT-morphologically cholesterol granulomas appear as soft-tissue density masses, which may display a discrete rim after intravenous administration of a contrast agent. The MRI, T1 as well as T2-weighted images show a strong signal in the area of the lesion. Depending on the individual anatomical conditions, the surgical access must be carefully chosen between transsphenoidal, transtemporal, infracochlear/-labyrinthine, or translabyrinthine. Here, we present the transsphenoidal and translabyrinthine access for the excision of cholesterol granulomas of the petrous apex. The different accesses are compared using a neuro-navigation-supported surgical technique with respect to its complications, drainage possibilities, outcomes, and recurrence of symptoms.
岩骨内需要占据空间或具有破坏性的病变常常给鉴别诊断带来挑战。岩尖胆固醇肉芽肿在临床上可能表现为听力丧失、眩晕、耳鸣、慢性头痛、面神经功能障碍、三叉神经神经痛，或因展神经麻痹而出现复视。在CT形态上，胆固醇肉芽肿表现为软组织密度肿块，静脉注射造影剂后可能显示出离散的边缘。MRI的T1加权和T2加权图像在病变区域显示出强信号。根据个体解剖情况，必须在经蝶窦、经颞骨、耳蜗下/迷路下或经迷路等手术入路之间仔细选择。在此，我们介绍经蝶窦和经迷路入路切除岩尖胆固醇肉芽肿。使用神经导航辅助手术技术对不同入路在并发症、引流可能性、手术效果和症状复发方面进行比较。
