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Updated: Jun 4, 2026
Endoscopic Cholesteatoma Surgery
Published on: January 19, 2022
Our experience in the management of petrous bone cholesteatoma
Karine Aubry1, Lana Kovac, Elisabeth Sauvaget
1ENT Department, Assistance Publique des Hôpitaux de Paris (AP-HP), Lariboisière Hospital (AP-HP), Paris, France.
Abstract:
We present the management of a series of petrous bone cholesteatomas. We performed a retrospective analysis on 28 patients with petrous bone cholesteatoma who underwent surgery between 1991 and 2008 at Lariboisiere Hospital, Paris, France. Main outcome measures included age of patients, surgical approaches, complications, and recurrence. The mean age was 47 years. Five were congenital cholesteatomas and 23 were acquired ones. Seventeen patients had undergone previous mastoid surgery elsewhere. Ninety-six percent of patients presented with hearing loss and 37.5% with facial nerve palsy. The surgical approaches varied according to the classification. Postoperatively, four patients developed facial nerve palsy; two patients, XII nerve paresis; one patient, X nerve paresis; and eight patients, deafness. The mean follow-up was 5 years. Twenty patients had no long-term recurrence. Two cases of petrous apex cholesteatoma presenting with double vision were removed by an endoscopic transsphenoidal approach. Control of the lesion was satisfactory in both cases. However, a minor pontic stroke resulted in transient hemiparesis in the case with dehiscent dura around the petrous bone cholesteatoma. Petrous bone cholesteatoma surgery is difficult. Lateral transtemporal and middle fossa approaches are classically used to remove petrous bone cholesteatoma. Recent progresses in endoscopic surgery, using image guidance system, allow removal of the petrous apex cholesteatoma by an endoscopic transsphenoidal approach with minimal morbidity.
Insights
Management of petrous bone cholesteatomas in 28 patients revealed varied surgical approaches and outcomes. Endoscopic techniques offer minimal morbidity for petrous apex cholesteatomas, with good lesion control.
Area of Science:
- Neurosurgery
- Otolaryngology
- Skull Base Surgery
Background:
- Petrous bone cholesteatomas are rare, challenging lesions requiring specialized surgical management.
- Both congenital and acquired cholesteatomas can lead to significant complications, including hearing loss and facial nerve palsy.
Purpose of the Study:
- To analyze the surgical management, outcomes, and recurrence rates of petrous bone cholesteatomas.
- To evaluate the effectiveness of different surgical approaches, including traditional and endoscopic techniques.
Main Methods:
- Retrospective analysis of 28 patients with petrous bone cholesteatoma treated between 1991 and 2008.
- Surgical approaches included lateral transtemporal, middle fossa, and endoscopic transsphenoidal routes.
- Outcomes assessed included age, complications, and recurrence rates with a mean follow-up of 5 years.
Main Results:
- 96% of patients presented with hearing loss and 37.5% with facial nerve palsy.
- Postoperative complications included facial nerve palsy, cranial nerve paresis (XII, X), and deafness.
- Twenty patients (71%) had no long-term recurrence; endoscopic transsphenoidal approach showed minimal morbidity for petrous apex cholesteatomas.
Conclusions:
- Petrous bone cholesteatoma surgery is complex, with varied approaches based on lesion classification.
- Traditional lateral transtemporal and middle fossa approaches remain relevant.
- Endoscopic transsphenoidal surgery represents a minimally invasive option for petrous apex cholesteatomas, offering satisfactory control with reduced morbidity.
