Combined Lateral Microscopic/Endoscopic Approach to Petrous Apex Cholesteatomas: An Example of Collaboration between Otologists and Rhinologists

Introduction: Petrous apex lesions are usually removed by microscopic lateral approaches. Total removal of those lesions can be difficult when they involve the most anterior part of the petrous apex. In that condition, endoscopic access from the sphenoid has been advocated and recently developed. However, it doesn't allow reaching the posterior part of the petrous apex and necessitate operating in a narrow corridor. The combination of a lateral microscopic approach, completed by the use of the endoscope allows exploring and removing extensive lesions of the petrous apex such as cholesteatomas. The aim of this communication is to establish the rationale and indications of this combined surgery.

Methods: 2 cases of extensive petrous apex cholesteatomas will be discussed, and the microscopic/endoscopic assisted technique will be illustrated by 2 videos of the surgery.

Results: Microscopic/endoscopic assisted technique allowed total removal of the cholesteatoma in our 2 patients without recurrence at 2 years. The use of the endoscope allowed the removal of the cholesteatoma easily to the sphenoid sinus. Correct instrumentation and perfect knowledge of the anatomy is mandatory to achieve safely the removal.

Conclusion: Microscopic/endoscopically assisted removal of petrous apex cholesteatomas is feasible and avoids the use of a double simultaneous approach by the nose and by the ear. Endoscopic anatomy of this area has now to be described and taught.