title: En bloc petrosectomy for malignant tumors involving the external auditory canal and middle ear: surgical methods and long-term outcome.
abstract: OBJECTIVE
  The aim of this study was to describe a method for resecting malignant tumors originating in the external auditory canal or middle ear and requiring en bloc resection of the petrous bone.
  
  
  METHODS
  Between 1995 and 2005, the authors performed en bloc petrosectomy for 18 malignant tumors in 9 male and 9 female patients, ranging in age from 15 to 74 years. Fourteen tumors originated in the external ear, 2 in the middle ear, and 2 in the parotid gland. The pathological entities included 15 squamous cell carcinomas, 2 adenoid cystic carcinomas, and 1 rhabdomyosarcoma. Through an L-shaped temporosuboccipital craniotomy, a medial osteotomy was created through the inner ear for tumors without extension into the inner ear (14 cases) and through the tip of the petrous bone for tumors reaching the inner ear (4 cases). Temporal dura mater in 3 patients and the base of the temporal lobe in 2 patients were included in the en bloc resection.
  
  
  RESULTS
  Surgical complications occurred in 5 patients (28%) with no deaths. During a mean follow-up period of 45 months, 3 patients died of tumor recurrence. Overall, 2- and 5-year survival rates were 86 and 78%, respectively. Two of three patients with dural extension and 1 of 2 with brain invasion remain alive. Two of four patients with tumor extension into the inner ear died.
  
  
  CONCLUSIONS
  En bloc petrosectomy is recommended for malignant tumors of the ear. It is safe and effective for lesions limited to the middle ear and may be the procedure of choice for tumors reaching the inner ear and those with dural or brain invasion.
authors.affiliation: Department of Neurosurgery, Kainan Hospital, Yatomi, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Okada
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Saito
authors.forename: Masakatsu
authors.initials: M
authors.lastname: Takahashi
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Hasegawa
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Fujimoto
authors.forename: Akihiro
authors.initials: A
authors.lastname: Terada
authors.forename: Yuzuru
authors.initials: Y
authors.lastname: Kamei
authors.forename: Jun
authors.initials: J
authors.lastname: Yoshida
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D004424:Ear Canal; D004428:Ear Neoplasms / Q000473:pathology / Q000601:surgery*; D004432:Ear, Middle; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D010027:Osteotomy / Q000379:methods*; D010579:Petrous Bone; D012189:Retrospective Studies; D012208:Rhabdomyosarcoma / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome