Circumferential petrosectomy for petrous apicitis and cranial base osteomyelitis.
OBJECTIVE
Petrous apicitis and cranial base osteomyelitis are life-threatening conditions. A surgical management may be necessary in cases that progress, in conditions that fail to improve with medical treatment, or in cases with impending complications. In this study, we describe a technique to remove the maximum amount of infected temporal bone while preserving the integrity of the peripheral auditory pathway and facial nerve.


METHODS
Retrospective study.


METHODS
Tertiary referral hospital.


METHODS
Five patients with impending complications, whose disease progressed or whose conditions failed to improve while on culture-directed antibiotics underwent circumferential petrosectomy.


METHODS
The circumferential petrosectomy removes most of the temporal bone around the external, middle, and inner ear. A combined retrolabyrinthine-apical petrosectomy is performed in conjunction with the fallopian bridge technique using a transmastoid and middle cranial fossa approach. A split temporalis muscle flap is used to bring vascularized tissue to the mastoid, jugular foramen, and petrous apex.


METHODS
Disease resolution, change in hearing or facial nerve function, complications.


RESULTS
Each of the five patients had modifications to the procedure tailored to their disease extent: three had disease primarily involving the petrous apex and two had disease adjacent to the jugular foramen. Additional cultures of the infected bone were obtained during surgery. A culture-directed antibiotic therapy (duration, 6-10 weeks) was administered after surgery, which resulted in the complete resolution of the disease and the associated symptoms in all five patients. No patient experienced hearing loss or facial nerve dysfunction as a result of the surgery within at least 1 year of follow-up in four of the five patients in this series.


CONCLUSIONS
The circumferential petrosectomy is a potential treatment option when medical treatment fails in patients with petrositis or cranial base osteomyelitis. It permits maximal temporal bone debridement while preserving hearing and facial nerve integrity in these life-threatening disease processes.
Visosky
Ann Marie B
AM
The Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas 77030, USA.
Isaacson
Brandon
B
Oghalai
John S
JS
D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003646:Debridement / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery; D008875:Middle Aged; D010000:Osteitis / Q000601:surgery*; D010019:Osteomyelitis / Q000601:surgery*; D013506:Otologic Surgical Procedures; D010579:Petrous Bone / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery; D013524:Surgical Flaps; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome