Learning Objectives: To discuss the surgical management of petrous bone (skull base) cholesteatoma To discuss the difficulty in recurrence in balance with preservation of anatomical structures To discuss the rates of hearing and facial nerve preservation in this disease.
Introduction: Petrous bone cholesteatoma medial to the otic capsule is very rare. Classification has been described by Moffat and Smith. Surgical management of the disease is extremely challenging and is a balance between total clearance of disease and preservation of critical anatomical structures including jugular bulb, carotid artery, middle and posterior cranial fossa dura. Resection of the disease from the labyrinth and facial nerve may cause devastating long term effects and must be considered in light of patient preference for revision surgery against long term deficits. We present a series of patients from the Manchester Skull Base Unit and the management of their disease.
Methods: A prospective database has been collated with all patients with petrous bone cholesteatoma managed in the unit. Surgery was dependent on site of disease. All patients were monitored with yearly DWI Propeller Sequence MRI to ensure no recurrence of disease.
Results: We present 63 patients who have presented with petrous bone cholesteatoma at a tertiary referral skull base unit, aged 10 to 87. 38 patients (60%) presented with a good functioning facial nerve (House Brackmann equivalent 1–2) and 21 (33%) presented with useable hearing. The most common location of disease was supralabyrinthine 33%) although 28 (44%) had apical disease.
Complications were limited with one patient developing a CSF leak, one patient an abdominal wall haematoma, and one patient an infection in the wound. Only 7 (11%) had residual hearing following surgery. 40 (63%) have a good functioning facial nerve (HB 1–2) post operatively at 1 year. 19 patients (30%) had residual or recurrent disease requiring repeated procedures.
Conclusions: Most patients can expect to maintain good facial nerve function despite aggressive surgery. Residual or recurrent disease can be monitored using advanced MRI technique and repeat surgery can be performed as necessary.
