Management of cholesteatoma in the petrous apex

Two cases of congenital and acquired cholesteatoma in the petrous apex were operated on via the translabyriathine approach. The cholesteatoma was removed, leaving a part of the matrix membrane in both cases as the matrix membrane was difficult to remove. Spaces including the mastoid and middle ear after removal of cholesteatoma were obliterated with only fibrin glue in order to pneumatize the operated space after surgery. Cerebrospinal fluid (CSF) leakage from the internal auditory meatus was prevented using a tiny fascia. The spaces occupied by the cholesteatoma were clearly pneumatized within 6 months after surgery in both patients. The advantage of creating pneumatized spaces after removal of cholesteatoms in the petrous apex was discussed.