Petrous Apex Cholesterol Granulomas: Outcomes, Complications, and Hearing Results From Surgical and Wait-and-Scan Management
| Autor: | Golda Grinblat, Francesco Galetti, Mario Sanna, Ashish Vashishth, Antonio Caruso |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Hearing loss Audiology 03 medical and health sciences Cholesterol granuloma Infracochlear Infralabyrinthine Infratemporal fossa approach Petrous apex Transotic Young Adult 0302 clinical medicine Postoperative Complications Audiometry Otology medicine Humans 030223 otorhinolaryngology Hearing Loss Watchful Waiting Aged Retrospective Studies Granuloma medicine.diagnostic_test business.industry Infratemporal fossa Postoperative complication Middle Aged Neurovascular bundle Sensory Systems Surgery Facial Nerve medicine.anatomical_structure Cholesterol Treatment Outcome Otorhinolaryngology Otologic Surgical Procedures Drainage Female Neurology (clinical) medicine.symptom Bone Diseases business 030217 neurology & neurosurgery Tinnitus Petrous Bone |
| Zdroj: | Otologyneurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology. 38(10) |
| ISSN: | 1537-4505 |
| Popis: | Objective 1. To analyze the surgical outcomes in the management of petrous apex cholesterol granulomas (PACG) with a brief literature review.2. To evaluate the importance of wait-and-scan management option. Study design Retrospective review. Setting Quaternary referral center for otology and skull base surgery. Subjects and methods Charts of 55 patients with at least 12 months of follow-up were analyzed for demographic, clinical, audiometric, and radiological features. Patients were divided into surgical group (SG) (n = 31) and wait-and-scan (n = 24) (WS) group. Surgical approach was chosen as per hearing status and PACG extension and relation to nearby neurovascular structures and included either drainage by transmastoid-infralabyrinthine approach (TM-IL)/transcanal-infracochlear approach (TC-IC) or resection by infratemporal fossa type B approach (ITF-B). The combination of ITF-B with trans-otic (TO) approach or TO approach solely was used in unserviceable hearing cases. Postoperative outcomes and complications were evaluated in SG. Results Postoperative symptom relief was observed in 24 patients (77.4%). Diplopia and paresthesia recovered in each case and improvement in headache, dizziness, tinnitus, and hearing loss was observed in 87.1% cases. Serviceable hearing was preserved in 24 of 26 cases. Postoperative complication rate was 32.2% including incidences of profound hearing loss, facial nerve paresis, carotid artery injury and intraoperative CSF leaks. Revision surgery was required in 3 (9.6%) cases, after TM-IL approach. Conclusion Surgical drainage is preferable to more aggressive resection procedures, with the latter reserved for recurrent lesions or lesions with severe hearing loss/involvement of critical neurovascular structures. ITF-B approach provides adequate cyst and neurovascular control for resection, while avoiding brain retraction. An initial wait-and-scan approach can be used in most patients where symptoms and imaging justify so. |
| Databáze: | OpenAIRE |
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