title: Petrosal cholesteatoma: management considerations for minimizing morbidity.
abstract: OBJECTIVE
  This study aimed to analyze the surgical treatment of patients presenting with petrosal cholesteatoma.
  
  
  METHODS
  The study design was a retrospective case review.
  
  
  METHODS
  The study was conducted at a tertiary referral center.
  
  
  METHODS
  Patients were referred to the University Department of Otolaryngology, Manchester Royal Infirmary, with surgically confirmed petrosal cholesteatoma.
  
  
  METHODS
  Interventions were diagnostic and therapeutic.
  
  
  METHODS
  Postoperative facial function, hearing loss, recurrent cholesteatoma, and petrous cavity morbidity in relation to preoperative signs, intraoperative findings, and surgical techniques were measured.
  
  
  RESULTS
  Twenty-five patients were treated between 1979 and 1997. Complete preoperative facial paralysis was always associated with bony erosion around the geniculate ganglion, and facial nerve ischemia was thought to be an important factor. Resection of the ischemic nerve segment and end-to-end anastomosis over the posterior fossa dura allowed full removal of cholesteatoma matrix and reinnervation along a healthy and vascularized nerve. In five of the seven cases with recurrent disease, cholesteatoma was localized to the intrapetrous carotid or geniculate ganglion. The introduction of endoscopic techniques has allowed assessment of the full extent of disease and removal of cholesteatoma matrix missed using conventional microscopic visualization. Bipolar diathermy to areas of cholesteatoma, densely adherent to dura, is effective in destroying squamous epithelium. Patients with cavity obliteration and blind sac closure had minimal postoperative morbidity, and current magnetic resonance imaging techniques are effective in diagnosing and delineating recurrence.
  
  
  CONCLUSIONS
  This study illustrates a gradual change in the treatment of patients with petrosal cholesteatoma. By defining the main areas of patient morbidity and using both recent technical advances and alternative surgical techniques, further improvement in patient outcome is envisaged.
authors.affiliation: University Department of Otolaryngology, Manchester Royal Infirmary, United Kingdom.
authors.forename: P R
authors.initials: PR
authors.lastname: Axon
authors.forename: N
authors.initials: N
authors.lastname: Fergie
authors.forename: S R
authors.initials: SR
authors.lastname: Saeed
authors.forename: R H
authors.initials: RH
authors.lastname: Temple
authors.forename: R T
authors.initials: RT
authors.lastname: Ramsden
mesh_terms: D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D001847:Bone Diseases / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D002339:Carotid Arteries / Q000473:pathology; D002648:Child; D002781:Cholesteatoma / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D003388:Cranial Fossa, Posterior / Q000601:surgery; D004388:Dura Mater / Q000601:surgery; D004724:Endoscopy / Q000379:methods; D005154:Facial Nerve / Q000098:blood supply / Q000473:pathology / Q000502:physiology; D005158:Facial Paralysis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005830:Geniculate Ganglion / Q000473:pathology; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010579:Petrous Bone / Q000473:pathology* / Q000601:surgery*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care; D020127:Recovery of Function; D012189:Retrospective Studies; D055502:Secondary Prevention; D012720:Severity of Illness Index; D016896:Treatment Outcome