Scienze Chirurgiche Department, Sapienza University of Rome, Italy.
Organi di Senso Department, Sapienza University of Rome, Italy.
Ear Nose Throat J. 2024 Jun;103(6):NP374-NP381. doi: 10.1177/01455613211056554. Epub 2021 Nov 19.
: Petrous bone cholesteatoma (PBC) is a rare condition of the petrous portion of the temporal bone. Treatment of choice consists of radical surgical removal, paying attention to protect the facial nerve and inner ear as far as possible. The aim of the present study was to evaluate the efficacy of modified translabyrinthine techniques in preserving hearing function and the use of the adjuvant endoscopic techniques in a group of PBC patients. : This study comprised 16 cases of PBCs surgically treated in our Department. Pre- and post-operative hearing status was assessed with pure tone audiometry and speech discrimination and graded according to the Gardner- Robertson classification system. Facial function was based on the House Brackman (HB) classification. PBCs were grouped using Sanna's classification. The choice of surgical technique was based on the above findings together with preoperative evidence. Post-operative follow-up ranged from 1 to 10 years and also included Computed Tomography and Magnetic Resonance Imaging assessment. : PBCs were classified as follows: 37.5% infralabyrinthine; 43.75% supralabyrinthine; and 18.75% massive. Preservation of the bone conduction threshold was feasible in 62.5% of patients. For supralabyrinthine PBCs a subtotal petrosetomy was performed in all cases and hearing preservation was possible in 57% of them: an adjuvant endoscopic approach was performed in 43%. Infralabyrinthine PBCs were treated using a modified translabyrinthine approach with preservation of bone conduction in 83% of patients; an adjuvant endoscopic approach was performed in 50% cases. One patient with a massive cholesteatoma was treated by modified translabyrinthine approach, preserving a serviceable level of hearing. In all massive cases, an adjuvant endoscopic approach was performed. In 2 patients with preoperative palsy, facial nerve function showed an improvement. The follow-up period revealed evidence of limited recurrence at CT imaging in 2 patients. : The introduction of modified surgical approaches, able to preserve the anatomical-functional structures, have shown an improvement of post-operative hearing outcomes.
岩骨胆脂瘤（PBC）是颞骨岩部的一种罕见疾病。首选的治疗方法是根治性手术切除，尽可能注意保护面神经和内耳。本研究旨在评估改良迷路入路技术在保留听力功能方面的疗效，并在一组 PBC 患者中使用辅助内镜技术。
本研究包括在我院接受手术治疗的 16 例 PBC 患者。术前和术后听力状况通过纯音测听和言语辨别力评估，并根据 Gardner-Robertson 分类系统进行分级。面神经功能基于 House Brackman（HB）分类。根据 Sanna 分类对 PBC 进行分组。手术技术的选择基于上述发现以及术前证据。术后随访时间为 1 至 10 年，还包括计算机断层扫描和磁共振成像评估。
PBC 分为以下几类：37.5% 迷路下；43.75% 迷路上；18.75% 巨大型。62.5%的患者可行骨导阈值保留。对于迷路上 PBC，所有病例均行次全岩骨切除术，其中 57%可保留听力：43%行辅助内镜检查。迷路下 PBC 采用改良迷路入路治疗，83%的患者保留骨导听力：50%行辅助内镜检查。1 例巨大胆脂瘤患者采用改良迷路入路治疗，保留了可使用的听力水平。所有巨大型病例均行辅助内镜检查。在 2 例术前面神经瘫痪的患者中，面神经功能有所改善。随访期间，2 例患者 CT 影像学显示有限复发。
改良手术方法的引入，能够保留解剖功能结构，改善术后听力结果。
