Department of Otology and Skull Base Surgery, Eye and ENT Hospital, Fudan University, Shanghai, People's Republic of China; NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, People's Republic of China.
Department of Neurosurgery, Peace Hospital of Changzhi Medical College, Changzhi, People's Republic of China.
World Neurosurg. 2020 Nov;143:84-90. doi: 10.1016/j.wneu.2020.07.143. Epub 2020 Jul 27.
Microsurgery is the reference standard treatment of petrous bone cholesteatoma (PBC). In most cases, radical removal of an extensive PBC can only be achieved at the cost of sacrificing the cochlea. Such treatment will result in the impossibility of future cochlear implantation for hearing rehabilitation purposes. To address this issue, a modification of the traditional translabyrinthine (TL) approach with endoscopic assistance has been developed for radical removal of extensive PBC with preservation of the cochlea.
From June 2017 to December 2017, 3 patients with a massive PBC underwent surgical removal using the modified TL approach by the senior author in our department. We reviewed the patient characteristics and retrospectively studied the surgical outcomes and postoperative complications. In the present report, we have described our modified TL approach in detail.
Complete resection of the PBC and successful cochlea preservation were achieved in all 3 patients. No recurrence had developed during the follow-up period. However, various degrees of cochlear ossification were observed in 2 patients postoperatively.
This modified TL approach provides the possibility of fully exposing the whole petrous apex without removing the cochlea in selected cases. However, the development of long-term cochlear ossification requires further investigation to allow for successful cochlear implantation.
显微镜手术是治疗岩骨胆脂瘤（PBC）的参考标准治疗方法。在大多数情况下，为了彻底清除广泛的 PBC，只能以牺牲耳蜗为代价。这种治疗方法将导致未来无法进行耳蜗植入以实现听力康复。为了解决这个问题，我们开发了一种改良的经迷路（TL）方法，通过内镜辅助，可以在保留耳蜗的情况下彻底清除广泛的 PBC。
自 2017 年 6 月至 2017 年 12 月，我们科室的资深作者对 3 例巨大 PBC 患者采用改良 TL 入路进行了手术切除。我们回顾了患者的特征，并对手术结果和术后并发症进行了回顾性研究。在本报告中，我们详细描述了我们改良的 TL 入路。
3 例患者均成功地彻底切除了 PBC 并保留了耳蜗。在随访期间无复发。然而，术后 2 例患者出现不同程度的耳蜗骨化。
在选择的病例中，这种改良的 TL 入路提供了在不切除耳蜗的情况下充分暴露整个岩尖的可能性。然而，长期耳蜗骨化的发展需要进一步研究，以实现成功的耳蜗植入。
