Our Experience in the Management of Petrous Bone Cholesteatoma

We present the management of a series of petrous bone cholesteatomas. We performed a retrospective analysis on 28 patients with petrous bone cholesteatoma who underwent surgery between 1991 and 2008 at Lariboisiere Hospital, Paris, France. Main outcome measures included age of patients, surgical approaches, complications, and recurrence. The mean age was 47 years. Five were congenital cholesteatomas and 23 were acquired ones. Seventeen patients had undergone previous mastoid surgery elsewhere. Ninety-six percent of patients presented with hearing loss and 37.5% with facial nerve palsy. The surgical approaches varied according to the classification. Postoperatively, four patients developed facial nerve palsy; two patients, XII nerve paresis; one patient, X nerve paresis; and eight patients, deafness. The mean follow-up was 5 years. Twenty patients had no long-term recurrence. Two cases of petrous apex cholesteatoma presenting with double vision were removed by an endoscopic transsphenoidal approach. Control of the lesion was satisfactory in both cases. However, a minor pontic stroke resulted in transient hemiparesis in the case with dehiscent dura around the petrous bone cholesteatoma. Petrous bone cholesteatoma surgery is difficult. Lateral transtemporal and middle fossa approaches are classically used to remove petrous bone cholesteatoma. Recent progresses in endoscopic surgery, using image guidance system, allow removal of the petrous apex cholesteatoma by an endoscopic transsphenoidal approach with minimal morbidity.