Author(s)
Anubhav G Amin, MD
Christopher Linstrom, MD
Lawrence Z Meiteles, MD
Katrina R Stidham, MD
Raj Murali, MD
Affiliation(s)
Department of Neurosurgery, New York Medical College, Westchester Medical Center, Department of Otolaryngology, New York Medical College, Westchester Medical Center and New York Eye and Ear Infirmary
Abstract:
Cholesteatomas are commonly encountered in the middle ear as a consequence of chronic infection. Large cholesteatomas of the petrous apex are much less common and may be congenital in origin. We present 5 cases of extremely large petroux apex cholesteatomas. Three patients presented with CSF otorrhea. Two patients presented with facial paralysis. One patient also had a temporal encephalocele. All patients had comprehensive imaging studies with both CT & MR scans.
We highlight the features that differentiate cholesteatoma from other entities such as cholesterol granuloma. These features allowed us to make a precise diagnosis of cholesteatoma in every case before surgery. The lesions had a tendency to relentlessly destroy every tissue in the their vicinity, including neurovascular structures, bone ,cochlea, labyrinth, and dura.
All of the patients underwent surgical resection the cholesteatomas were approached from either the mastoid alone or in combination with a small temporal craniotomy.The CSF otorrhea was stopped in all cases and the temporal encephalocele was successfully repaired by combined approach involving both craniotomy & tympanomastoidectomy. Facial nerve palsy improved in one patient and did not improve in the other.
Our presentation will include detailed radiological imaging and details of the surgical procedure.
In summary, we will show the clinical features, radiological imaging, and surgical details of petrous apex cholesteatomas. We also emphasize their chronic, indolence course until they present with a serious symptom such as facial nerve paralysis or CSF otorrhea.