Rueda Vega Monica, López Granados Carolina, Martín Oviedo Carlos, Arístegui Torrano Ignacio, Arístegui Ruiz Miguel
Department of Otolaryngology-Head and Neck Surgery, Hospital General Universitario Gregorio Marañón, C/Doctor Esquerdo, 46. 3rd Floor, 28007, Madrid, CP, Spain.
Eur Arch Otorhinolaryngol. 2025 May;282(5):2349-2365. doi: 10.1007/s00405-024-09144-4. Epub 2024 Dec 19.
The aim of this study is to assess the clinical characteristics, classification, surgical approaches, interventional strategies, and treatment outcomes of patients with petrous bone cholesteatoma (PBC).
Observational retrospective study of patients with PBC managed by the senior author of this paper between 1995 and 2024 in a tertiary referral center. A literature review was made, identifying 16 articles. Clinical presentations, Sanna's classification, pre- and post-surgical facial function and audiometry, surgical approach and intraoperative endoscopic assistance, postoperative complications, and recurrence rates were reported.
We report on a large series of 94 cases managed by the senior author. The most common type was supralabyrinthine PBCs (40.43%; 38 cases), followed by massive (18.09%; 17). Hearing loss was present in almost all the patients (98.91%). The most frequent approaches were the modified translabyrinthine approach (24.51%; 25), the subtotal petrosectomy (22.55%; 23) and the transotic approach (18.63%; 19). In 11 patients the approach was assisted by the use of an endoscope. Recurrence of PBC was identified in 8 cases (8.51%) that were surgically resolved. Additionally, we report a review of the literature (16 articles).
We focus on the introduction of endoscopic assisted techniques that may help in reducing the rate of residual and avoid rerouting of the facial nerve. At the same time, we encourage techniques that include elimination of the middle ear through a subtotal petrosectomy, as they are essential to protect vital structures that have been exposed by the disease or by the surgical technique.
本研究旨在评估岩骨胆脂瘤（PBC）患者的临床特征、分类、手术入路、介入策略及治疗效果。
对本文资深作者于1995年至2024年在一家三级转诊中心治疗的PBC患者进行观察性回顾性研究。进行文献综述，共识别出16篇文章。报告了临床表现、桑纳分类、手术前后的面部功能和听力测定、手术入路及术中内镜辅助、术后并发症和复发率。
我们报告了资深作者治疗的94例大量病例。最常见的类型是迷路上型PBC（40.43%；38例），其次是巨大型（18.09%；17例）。几乎所有患者（98.91%）都存在听力损失。最常用的手术入路是改良经迷路入路（24.51%；25例）、岩骨次全切除术（22.55%；23例）和经外耳道入路（18.63%；19例）。11例患者的手术入路由内镜辅助。8例（8.51%）手术治疗的PBC患者出现复发。此外，我们还报告了文献综述（16篇文章）。
我们重点介绍了内镜辅助技术，这些技术可能有助于降低残留率并避免面神经改道。同时，我们鼓励采用通过岩骨次全切除术消除中耳的技术，因为这些技术对于保护因疾病或手术技术而暴露的重要结构至关重要。
