The Surgical Management of Petrous Bone Cholesteatomata: A Case Series Review and Reflections from the Literature

Introduction: Petrous bone cholesteatomata presents a number of challenges in its management. The facial nerve and labyrinth are commonly involved at presentation. Surgical access for resection of disease is limited by the close proximity of key structures. Surgery for petrous bone cholesteatomata is associated with a significant risk of injury to these structures, with hearing loss and facial weakness being the two most commonly reported complications. The loss of function in these structures can be extremely debilitating; therefore, in cases where they are intimately involved in cholesteatoma it may be preferable to leave residual disease in place rather than to risk injury through complete removal and a resultant loss of function.

Objective: To present a case series review of patients presenting with petrous bone cholesteatomata who underwent surgical intervention. The presenting features, clinical findings, classification, surgical approaches, operative findings, and outcomes following surgery are discussed.

Design: Retrospective case note review and analysis.

Patients/Materials and Methods: Thirty-three patients presenting with petrous bone cholesteatomata who were treated surgically at University Hospital Birmingham or Birmingham Children's Hospital between 1999 and 2012.

Results: The presenting features, classification, surgical approach, operative findings, outcomes (including impact of surgery on function and rate of recurrent disease) are described and in turn related to findings from other case series in the published literature. The learning points from this and their influence on the clinical management of petrous bone cholesteatomata are discussed.