Subtotal Petrosectomy in Middle Ear Surgery: Insights From 40 Years of Experience at “Gruppo Otologico”

Objectives: To highlight our over 40 years of experience with subtotal petrosectomy (STP), we aim to present updated information on its technique, indications, and long-term outcomes. Study design: A retrospective case series study was conducted in a private quaternary skull base center. Materials and methods: The medical records of 900 cases of STP performed between 1983 and 2023 were thoroughly evaluated in this study. The assessment encompassed symptoms and signs, preoperative and postoperative audiological parameters, radiologic and surgical details, diagnoses, and complications. Results: Six hundred eighty-seven (65.2%) patients had undergone multiple surgeries before a STP was performed. The most common indication for STP was middle ear cholesteatoma, with 344 (38.2%) patients. Challenging cases of cochlear implantation, meningoencephalic herniation, class B3 paragangliomas, and temporal bone fractures, with 281 (31.2%), 68 (7.6%), 52 (5.8%), and 37 (4.1%) cases, respectively. The mean follow-up time for our patients was 40.7 months, with a median follow-up of 24.6 months. The most common complications were recidivism and postauricular wound fistula, occurring in 12 and 9 patients, respectively. To the best of our knowledge, this series is the largest documented cohort in the literature to date. Conclusions: STP should be regarded as the preferred approach for a range of challenging situations in otology, as it offers the potential for a definitive cure through radical clearance. In addition, this procedure can be safely combined with various other otologic and lateral skull base surgical procedures, including hearing implantation.