Subarcuate supralabyrinthine approach for supralabyrinthine petrosal cholesteatoma.
Congenital cholesteatomas of the petrosal apex account for 1% to 3% of all cholesteatomas and often present an important surgical challenge. This report describes an exceptional case of a "nondestructive" translabyrinthine surgical approach to a large congenital petrosal cholesteatoma that threatened the vestibulum, superior semicircular canal, facial nerve, and internal auditory canal. We applied a nonconventional transmastoid subarcuate supralabyrinthine approach in a 20-year-old patient by accessing the lesion through the center of the superior semicircular arch without damaging the integrity of the canal. This led to a complete removal of the petrosal cholesteatoma with preservation of hearing and vestibular function. Follow-up imaging performed 1 and 2 years after operation by means of non-echo-planar diffusion-weighted imaging did not show residual cholesteatoma. This report describes the first successful use of a subarcuate supralabyrinthine approach through the arches of the superior semicircular canal in a case of petrosal cholesteatoma.
University Department of Otolaryngology-Head and Neck Surgery, St Augustinus Hospital, Antwerp, Belgium.
Joost J S
JJ
van Dinther
Jean-Philippe
JP
Vercruysse
Bert
B
De Foer
Thomas
T
Somers
Andrzej
A
Zarowski
Jan
J
Casselman
Erwin
E
Offeciers
D000328:Adult; D018424:Cholesteatoma, Middle Ear / Q000175:diagnosis / Q000601:surgery*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D013506:Otologic Surgical Procedures / Q000379:methods*; D012665:Semicircular Canals / Q000601:surgery; D014057:Tomography, X-Ray Computed