Principles of surgical treatment of giant petrous bone cholesteatoma

This article presents the results of our own surgical treatment of giant cholesteatoma of the petrous part of the temporal bone in the Department of Pathology of the Ear and Skull Base of the National Medical Research Center of Otorhinolaryngology for the period from 2018 to 2021. Pre- and postoperative medical history, radiological examination data, pre- and postoperative function of the facial muscles according to the House–Brackmann scale, intraoperative features, pre- and postoperative function of the vestibular system, postoperative complications and relapses are presented. Various types of surgical access were used depending on the location and spread of massive cholesteatoma to adjacent anatomical structures: in 4 cases, transcochlear approach; in 2 cases, translabyrinthine approach; and in 1 case, subtotal petrosectomy. Possible options for completing the operation are described (obliteration of the auditory tube, trepanation cavity with autologous fat, closure of the cavity with a pedicled temporalis muscle flap, or cul-de-sac closing the external auditory canal). An analysis of the literature from 2017 to 2021 was carried out, presenting clinical cases of cholesteatoma of the pyramid of the temporal bone with massive spread (Pubmed). A total of 17 publications were analyzed based on the type of classification of petrous bone cholesteatoma used, the total number of cases with large spread of cholesteatoma, the type of surgical approach, and the frequency of recurrence and complications. The total number of patients with petrous bone cholesteatoma was 716 people. The most common surgical options were subtotal petrosectomy and the middle fossa approach.