Vasdev A, Boubagra K, Lavieille J P, Bessou P, Lefournier V
Service de Neuro radiologie, CHU de Grenoble, Hôpital A. Michallon.
J Neuroradiol. 1994 Apr;21(3):181-93.
The authors present their experience of secondary cholesteatomas of the middle ear explored by computerized tomography (CT). Following a brief anatomicopathological description of secondary petrous bone cholesteatomas, and of the CT technique used for their exploration, they describe and illustrate the classical "bag-shaped" internal or external attical forms usually extended to the antrum and the mastoid process, and the less common locations often due to relapse or postoperative recurrences (anterior hypotympanic or posterior mastoidal). The holotympanic forms, usually due to "lamellar" cholesteatomas, create diagnostic problems with other opacities in the cavity, as also do certain forms that are evacuated spontaneously or by aspiration. One of the qualities of CT lies in the preoperative extension assessment. The lesion may extend towards the internal wall of the cavity (lateral semicircular canal, second portion of the facial nerve), towards the labyrinth to the petrosal apex and/or the geniculate ganglion, and above all towards the inferior labyrinth which might bring the cholesteatoma into contact with large vessels (e.g. jugular vein bulb for postero-inferior extensions, carotid canal for antero-inferior extensions). Extension into anfractuosities of the cavity walls (sinus tympani, subratubal fossette) must be systematically looked for in order to avoid postoperative recurrences.
作者介绍了他们通过计算机断层扫描（CT）对中耳继发性胆脂瘤的研究经验。在对颞骨继发性胆脂瘤进行简要的解剖病理学描述以及用于研究的CT技术之后，他们描述并展示了通常延伸至鼓窦和乳突的典型“袋状”内耳道或外耳道形式，以及较少见的位置，这些位置通常是由于复发或术后再发（前下鼓室或后乳突）。全鼓室形式通常由“层状”胆脂瘤引起，与腔内其他混浊病变一样，会产生诊断问题，某些自发排出或通过抽吸排出的形式也是如此。CT的优点之一在于术前对病变范围的评估。病变可能向鼓室的内壁（外侧半规管、面神经第二段）、向迷路延伸至岩尖和/或膝状神经节，最重要的是向下迷路延伸，这可能使胆脂瘤与大血管接触（例如后下延伸时的颈静脉球、前下延伸时的颈动脉管）。必须系统地检查病变是否延伸至鼓室壁的隐窝（鼓室窦、咽鼓管下隐窝），以避免术后复发。
