Subtotal petrosectomy in children: Indications, outcomes, and age-related patterns in a pediatric cohort

Subtotal petrosectomy (STP) is a radical otologic procedure aimed at complete eradication of diseased temporal bone air cells and creation of a closed, sterile cavity. While well established in adult otology, its role in pediatric patients remains insufficiently described.

To analyze current indications, outcomes and complication rates of subtotal petrosectomy in a pediatric population, with particular emphasis in age - related patterns of indications.

A retrospective review was conducted of 20 children (<18 years) who underwent STP between 2010 and 2024 at two tertiary referral centers. Patients were analyzed according to age groups (≤6 years vs. >6 years) and etiology, categorized as congenital (including congenital malformations, CHARGE syndrome and congenital CSF leaks) or acquired (cholesteatoma, chronic otitis media, traumatic and oncological lesions). Major and minor complications were recorded and analyzed using non - parametric statistical methods.

The cohort included 15 boys and 5 girls with a mean follow-up of 4.3 ± 1.2 years. Congenital indications predominated in children ≤6 years, whereas acquired pathologies were significantly more common in older children (>6 years) (Fisher's exact test, p = 0.018). Patients treated for congenital indications were significantly younger than those with acquired pathologies (p = 0.0095). Major complications occurred in 2 of 20 patients (10%, 95% confidence interval 1,2-31,7%), including cholesteatoma recurrence requiring revision surgery and conversion to an open technique. Minor complications were observed in one patient (5%) and consisted of an abdominal hematoma). No cases of implant loss, permanent facial nerve palsy or wound dehiscence were observed.

STP is a safe and effective procedure in selected pediatric patients, with low rates of major complications. Indications differ significantly by age, with congenital pathology predominating in younger children and acquired in older patients. In children, STP should be regarded not as salvage procedure but as a reconstructive strategy providing a stable anatomical foundation for long term hearing rehabilitation and disease control.