Section: 
Reviews
ReviewsAdvantages of endoscopic assistance surgery of petrous bone cholesteatoma
Kh. M. Diab (1), O. A. Pashchinina (2), P. A. Lagieva (3), O. S. Panina (4), A. E. Mikhalevich (5)
(1), (2), (3), (4), (5) National Medical Research Center of Otolaryngology, Federal Medical and Biological Agency, Moscow, 123182, Russian Federation, (1) Pirogov Russian National Research Medical University, Moscow, 117197, Russian Federation
UDK: УДК 616.284-002.258-072.1
DOI: https://doi.org/10.18692/1810-4800-2024-6-106-115
ABSTRACT
Abstract. Introduction. The temporal bone is considered the most complexly organized bone of the human skull as it borders on many important anatomical structures of the skull and neck such as the labyrinth capsule, the internal auditory canal, the facial nerve, the internal carotid artery, the sigmoid sinus, the bulb of the jugular vein, the temporal lobe of the brain, the cerebellum, and the brain stem in complex spatial relationships. The pathology of the temporal bone is diverse, but the cholesteatoma of the pyramid at the same time occupies one of the leading positions and is composed (4–9%). Treatment of patients with petrous bone cholesteatoma (PBC) is traditionally considered difficult for both otosurgeons and neurosurgeons and involves the difficulty of removing the matrix from neurovascular structures, meninges; complex debridement of hard-to-reach spaces (sphenoid sinus, nasopharynx, occipital condyle, paravertebral space) while preserving hearing, integrity, and facial nerve function; with a sufficiently high risk of developing residual and recurrent cholesteatoma. Objective. To analyze the literature data on the use of endoscopic assistance in surgery of PBC. Materials and methods. The analysis of articles describing the use of endoscopic techniques in patients with PBC was carried out. The scope of the study was 18 years, for the period from 2004 to 2022. The number of patients included in the study was 173, which allows us to come to certain conclusions and outline ways to improve the effectiveness of surgical treatment of patients with PBC. Discussion. The spread of the cholesteatoma into the petrous apex, the sphenoid sinus, nasopharynx, occipital condyle, or between important neurovascular structures makes the complete microsurgical removal of the PBC a difficult task, often requiring even larger entrance gates of the surgical field. Endoscopic assistance can play an important auxiliary role in surgery of a PBC allowing timely identification of a residual cholesteatoma, debridement hard-to-reach places, in some cases preserving hearing and facial function. A number of authors have justified the combined approach of microscopy and endoscopic techniques, which avoids destruction of the temporal bone and surrounding structures, thereby reducing the occurrence of complications. The creeping nature of the process on the surfaces of the facial nerve, internal carotid artery, meninges, spreading into corners and crevices between structures are among the main difficulties during the treatment of the PBC and are the main causes of intraoperative complications. Conclusions. As studies have shown, the endoscopic method in combination with the microscopic approach allows reducing the number of relapses and residual cholesteatoma, makes it possible to preserve the facial nerve in its canal, allows using hearing-preserving approaches in a greater number of cases (the microscope has a straight line view, the endoscope has the ability to have an angular view), reduces the average time of work during intraoperative use in comparison with the use of a microscope only.
Publication date:
17.12.2024
Keywords:
petrous bone cholesteatoma, endoscopic technique, combined microscopic and endoscopic approach, residual cholesteatoma
For citation:
Diab Kh. M., Pashchinina O. A., Lagieva P. A., Panina O. S., Mikhalevich A. E. Advantages of endoscopic assistance surgery of petrous bone cholesteatoma. Russian Otorhinolaryngology. 2024;23(6):106-115. (In Russ.) https://doi.org/10.18692/1810-4800-2024-6-106-115