CC BY-NC-ND 4.0 · Laryngorhinootologie 2020; 99(S 02): S315
DOI: 10.1055/s-0040-1711275
Abstracts
Otology

The cholesteatoma of the petrous apex: resection via an infracochlear approach

T Jakob
1   Universitätsklinikum Freiburg, Medizinische Fakultät, Albert- Ludwigs-Universität Freiburg, Deutschland, Klinik für Hals-, Nasen- und Ohrenheilkunde Freiburg
,
S Arndt
1   Universitätsklinikum Freiburg, Medizinische Fakultät, Albert- Ludwigs-Universität Freiburg, Deutschland, Klinik für Hals-, Nasen- und Ohrenheilkunde Freiburg
,
A Aschendorff
1   Universitätsklinikum Freiburg, Medizinische Fakultät, Albert- Ludwigs-Universität Freiburg, Deutschland, Klinik für Hals-, Nasen- und Ohrenheilkunde Freiburg
,
R Beck
1   Universitätsklinikum Freiburg, Medizinische Fakultät, Albert- Ludwigs-Universität Freiburg, Deutschland, Klinik für Hals-, Nasen- und Ohrenheilkunde Freiburg
,
A Knopf
1   Universitätsklinikum Freiburg, Medizinische Fakultät, Albert- Ludwigs-Universität Freiburg, Deutschland, Klinik für Hals-, Nasen- und Ohrenheilkunde Freiburg
,
M Ketterer
1   Universitätsklinikum Freiburg, Medizinische Fakultät, Albert- Ludwigs-Universität Freiburg, Deutschland, Klinik für Hals-, Nasen- und Ohrenheilkunde Freiburg
› Author Affiliations
 

Introduction The most common location of cholesteatoma is epitympanal. Infracochlear cholesteatoma of the petrous apex are rarely found. Anatomically, the location of the cholesteatoma between the cochlea and the internal carotid artery (ICA) is a challenge for the oto-surgeon and requires intensive patient education regarding the risk of deafness and bleeding.

Case vignette A 39-year-old patient presented with persistent otorrhea after three times tympanoplasty alio loco with cholesteatoma. The CT temporal bone showed a soft tissue formation of the petrous apex with contact to the ICA and the internal jugular vein. An MRI with cholesteatoma sequence (HASTE sequence) confirmed the suspicion of a cholesteatom of the petrous apex.

Results After case discussion in the interdisciplinary skull base conference, the recommendation was made for navigated infracochlear resection after an occlusion test of the ICA. Using a combined microscopic-endoscopic procedure, the cholesteatoma could be completely removed with the aid of a navigation pointer after prior mastoidectomy with canal wall down. The hearing rehabilitation was carried out with a TORP. Postoperatively, the inner ear showed almost normal hearing with a minimal conductive hearing loss.

Conclusion In addition to the transmeatal infracochlear access to the petrous apex, it can also be achieved transcranially, transmastoidally, transsphnoidally or translabyrintharily, depending on the exact location of the process to be achieved. These accesses can also be used for sampling of unclear processes of the petrous apex. The transmeatal infracochlear access is associated with the lowest risk of morbidity.



Publication History

Article published online:
10 June 2020

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