The Medially-Invasive Cholesteatoma: An Aggressive Subtype of a Common Pathology

Area of Science:

• Otolaryngology
• Neurosurgery
• Skull Base Surgery

Background:

• Medially-invasive cholesteatomas pose significant surgical challenges due to their aggressive, endophytic growth patterns.
• These cholesteatomas can erode into the otic capsule, petrous apex, and skull base, requiring specialized management.

Purpose of the Study:

• To describe the treatment outcomes for patients with cholesteatomas that are medially invasive to the otic capsule, petrous apex, and/or skull base.
• To evaluate the efficacy and complications of surgical management for this challenging condition.

Main Methods:

• A retrospective case series was conducted at two tertiary care academic centers.
• Seven patients surgically managed for medially-invasive cholesteatoma between 2001 and 2017 were reviewed.
• Data included presenting symptoms, imaging, pre- and post-operative clinical course, and complications.

Main Results:

• All seven patients presented with radiographic evidence of invasive cholesteatoma, with erosion beyond the lateral semicircular canal.
• Five patients had a history of recurrent cholesteatoma and multiple prior surgeries.
• Facial nerve function was preserved in all but one patient, and no cholesteatoma recurrence was observed.

Conclusions:

• Medially-invasive cholesteatoma exhibits aggressive growth, necessitating surgical resection as the primary treatment.
• Subtotal petrosectomy with ear closure is often required when cerebrospinal fluid (CSF) leak is a concern.
• Surgical management can achieve favorable outcomes, including preservation of facial nerve function and no recurrence.