Objective: To review the classification and management of petrous bone cholesteatomas (PBCs) at our center and the outcomes of facial nerve (FN) management in these lesions. Methods: This was a retrospective study. The setting was a quaternary referral center for skull base pathology in Italy. A total of 200 patients with 201 PBCs were included in the study. All patients diagnosed radiologically with PBCs were classified according to the Sanna classification. All patients were surgically treated and followed up with radiology. The main outcome measures - classification of PBCs, the surgical approach used, disease control, and FN outcomes - were analyzed. Results: Supralabyrinthine PBCs were the most common type with 92 cases (45.8%) followed by the massive PBCs with 72 cases (35.8%). Preservation of preoperative FN function was highest in the infralabyrinthine (72.2%) and infralabyrinthine-apical (73.3%) types. The transotic approach was used in 66 cases (32.8%) in this series. The modified transcochlear approach type A was applied in 55 cases (27.3%). Active management of the nerve (rerouting, anastomosis, or grafting) was required in 53 cases (26.4%). Postoperatively, of the 116 cases with FN House-Brackmann grade I and II, 107 cases (92.2%) retained the same grade or improved. Recurrence was seen in 7 cases (3.5%). The mean duration of follow-up was 6.3 years. Conclusions: Radical disease clearance must take precedence over hearing and FN preservation in PBCs. Active FN management, including rerouting, end-to-end anastomosis, and cable nerve grafting, routinely come to play in the surgical management of PBCs, and the postoperative FN results after such interventions can be satisfactory in most cases.

1.
Alvarez FL, Gomez JR, Bernardo MJ, Suarez C: Management of petrous bone cholesteatoma: open versus obliterative techniques. Eur Arch Otorhinolaryngol 2011;268:67-72.
2.
Axon PR, Fergie N, Saeed SR, Temple RH, Ramsden RT: Petrosal cholesteatoma: management considerations for minimizing morbidity. Am J Otol 1999;20:505-510.
3.
Aubry K, Kania R, Sauvaget E, Huy PT, Herman P: Endoscopic transsphenoidal approach to petrous apex cholesteatoma. Skull Base 2010a;20:305-308.
4.
Aubry K, Kovac L, Sauvaget E, Tran Ba Huy P, Herman P: Our experience in the management of petrous bone cholesteatoma. Skull Base 2010b;20:163-167.
5.
Chen Z, Wu N, Wang F, Li K, Ren L, Li J, Yang S: Clinical analysis of 38 cases of petrous apex cholesteatoma (in Chinese). Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2015;29:114-116.
6.
Danesi G, Cooper T, Panciera DT, Manni V, Cote DW. Sanna classification and prognosis of cholesteatoma of the petrous part of the temporal bone: a retrospective series of 81 patients. Otol Neurotol 2016;37:787-792.
7.
Gacek RR: Evaluation and management of primary petrous apex cholesteatoma. Otolaryngol Head Neck Surg 1980;88:519-523.
8.
Grayeli AB, Mosnier I, El Garem H, Bouccara D, Sterkers O: Extensive intratemporal cholesteatoma: surgical strategy. Am J Otol 2000;21:774-781.
9.
House JW, Brackmann DE: Facial nerve grading system. Otolaryngol Head Neck Surg 1985;93:146-147.
10.
Ishii K, Takahashi S, Matsumoto K, Kobayashi T, Ishibashi T, Sakamoto K, Soda T: Middle ear cholesteatoma extending into the petrous apex: evaluation by CT and MR imaging. Am J Neuroradiol 1991;12:719-724.
11.
Kim MJ, An YS, Jang MS, Cho YS, Chung JW: Hearing and facial function after surgical removal of cholesteatomas involving petrous bone. Clin Exp Otorhinolaryngol 2014;7:264-268.
12.
Lin Y, Chen Y, Lu LJ, Qiao L, Qiu JH: Primary cholesteatoma of petrous bone presenting as cervical fistula. Auris Nasus Larynx 2009;36:466-469.
13.
Magliulo G: Petrous bone cholesteatoma: clinical longitudinal study. Eur Arch Otorhinolaryngol 2007;264:115-120.
14.
Moffat D, Jones S, Smith W: Petrous temporal bone cholesteatoma: a new classification and long-term surgical outcomes. Skull Base 2008;18:107-115.
15.
Omran A, De Denato G, Piccirillo E, Leone O, Sanna M: Petrous bone cholesteatoma: management and outcomes. Laryngoscope 2006;116:619-626.
16.
Ozmen OA, Falcioni M, Lauda L, Sanna M: Outcomes of facial nerve grafting in 155 cases: predictive value of history and preoperative function. Otol Neurotol 2011;32:1341-1346.
17.
Pandya Y, Piccirillo E, Mancini F, Sanna M: Management of complex cases of petrous bone cholesteatoma. Ann Otol Rhinol Laryngol 2010;119:514-525.
18.
Pareschi R, Destito D, Righini S, Falco Raucci A, Mincione A, Colombo S: Petrous bone cholesteatoma: surgical strategy (in Italian). Acta Otorhinolaryngol Ital 2001;21:220-225.
19.
Persaud R, Hajioff D, Trinidade A, Khemani S, Bhattacharyya MN, Papadimitriou N, Kalan A, Bhattacharyya AK: Evidence-based review of aetiopathogenic theories of congenital and acquired cholesteatoma. J Laryngol Otol 2007;121:1013-1019.
20.
Rijuneeta, Parida PK, Bhagat S: Parapharyngeal and retropharyngeal space abscess: an unusual complication of chronic suppurative otitis media. Indian J Otolaryngol Head Neck Surg 2008;60:252-255.
21.
Sanna M, Khrais T, Mancini F, Russo A, Taibah A: Facial nerve management in petrous bone cholesteatoma surgery; in: The Facial Nerve in Temporal Bone and Lateral Skull Base Microsurgery. Stuttgart, Thieme, 2006, pp 237-258.
22.
Sanna M, Mazzoni A, Saleh E, Taibah A, Mancini F: The system of the modified transcochlear approach: a lateral avenue to the central skull base. Am J Otol 1998;19:88-97; discussion 97-98.
23.
Sanna M, Pandya Y, Mancini F, Sequino G, Piccirillo E: Petrous bone cholesteatoma: classification, management and review of the literature. Audiol Neurotol 2011;16:124-136.
24.
Sanna M, Piazza P, Shin SH, Flanagan S, Mancini F: Surgical management of class a and b tumors; in: Microsurgery of Skull Base Paraganglioma. Stuttgart, Thieme, 2013, pp 160-216.
25.
Sanna M, Saleh E, Khrais T, Mancini F, Piazza P, Russo A, Taibah A: The transcochlear approaches; in: Atlas of Microsurgery of the Lateral Skull Base. Stuttgart, Thieme, 2008, pp 80-126, 330-349.
26.
Sanna M, Shin SH, Mancini F, Russo A, Taibah A, Falcioni M: Middle Ear and Mastoid Microsurgery. Stuttgart, Thieme, 2012.
27.
Sanna M, Zini C, Gamoletti R, Frau N, Taibah AK, Russo A, Pasanisi E: Petrous bone cholesteatoma. Skull Base Surg 1993;3:201-213.
28.
Senn P, Haeusler R, Panosetti E, Caversaccio M: Petrous bone cholesteatoma removal with hearing preservation. Otol Neurotol 2011;32:236-241.
29.
Song JJ, An YH, Ahn SH, Yoo JC, Lee JH, Oh SH, Kim CS, Chang SO: Surgical management options and postoperative functional outcomes of petrous apex cholesteatoma. Acta Otolaryngol 2011;131:1142-1149.
30.
Steward DL, Choo DI, Pensak ML: Selective indications for the management of extensive anterior epitympanic cholesteatoma via combined transmastoid/middle fossa approach. Laryngoscope 2000;110:1660-1666.
31.
Tutar H, Goksu N, Aydil U, Baştürk Tutar V, Kizil Y, Bakkal FK, Bayazit YA: An analysis of petrous bone cholesteatomas treated with translabyrinthine transotic petrosectomy. Acta Otolaryngol 2013;133:1053-1057.
32.
Wu T, Han DY, Yang WY, Huang DL, Wu WM, Zhang SZ: Diagnosis and surgical management of petrous apex cholesteatoma (in Chinese). Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2004;39:258-261.
33.
Yanagihara N, Nakamura K, Hatakeyama T: Surgical management of petrous apex cholesteatoma: a therapeutic scheme. Skull Base Surg 1992;2:22-27.
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