Objective: By summarizing the technical points and therapeutic outcomes of combing infratemporal fossa approach (IFA) and internal carotid artery (ICA) reconstruction for the colossal skull base tumor invading ICA in petrous bone, the clinical application value was discussed. Methods: Five patients (2 males, 3 females,aging from 27 to 55 years old) who received surgeries between July 2015 and May 2017 for lateral skull base pathology involved petrous ICA using technique combined IFA and pre-reconstruction, were reviewed. Results: Among the five patients, three were paraganglioma of head and neck, one was carotid aneurysms, and one was recurrent adenoid cystic carcinoma (ACC). The median tumor size in the largest cross-section was 60 mm × 51 mm (range, 28 mm × 22 mm-72 mm × 58 mm). Complete excision was achieved with IFA and ICA reconstruction. The median blood loss volume was 1 000 ml (range, 600-2 500 ml). Four cases showed no new long-term neurologic sequelae, while one showed hemiplegia due to graft vessel occlusion. Except for the one with ACC having facial nerve cut, others achieved good facial nerve function of HB grade Ⅰ to Ⅱ during 3 to 12 months, follow-up. No tumor recurrence was observed over the median duration of follow-up for above 36 months (range, 36-58 months). Conclusion: For lesions involved superior part of ICA, which is unable to separate from ICA, IFA and ICA reconstruction can achieve complete excision.
Adult ; Carotid Artery, Internal/surgery* ; Female ; Humans ; Infratemporal Fossa ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Petrous Bone/surgery* ; Skull Base/surgery* ; Skull Base Neoplasms/surgery*

OBJECTIVE: This study aimed to assess the surgical results of the intradural transpetrosectomy for petrous apex meningiomas (PAMs). In addition, we describe the methods and techniques used to expose and manage superior petrous vein and greater superficial petrosal nerve.METHODS: The authors conducted a retrospective study of 16 patients with PAMs operated by the senior author via the intradural transpetrosectomy between February 2012 to May 2017. We reviewed patient data regarding the general characteristics, surgical technique and surgery-related outcomes and adopted a combined follow-up strategy of clinic and telephone contacts to evaluate postoperative complications.RESULTS: Simpson grade I and II resection was performed in 10 out of 16 cases (62.5%), and grade III resection were reported in the remaining six cases (37.5%) with no resultant mortality. The mean Karnofsky Performance Status score was 85.6 preoperatively and improved to 91.9 postoperatively, with a mean follow-up period of 34.4 months (range, 6–66 months). Tumor recurrence was found in two patients and they underwent the second surgical operation.CONCLUSION: PAMs could be completely resected by the intradural transpetrosectomy with an improved survival rate and postoperative life quality. Superior petrous vein and greater superficial petrosal nerve should be managed properly in avoidance of postoperative complications. Finally, most meningioma inside cavernous sinus or adhered to brainstem could be totally removed without postoperative complications.
Brain Stem ; Cavernous Sinus ; Follow-Up Studies ; Humans ; Karnofsky Performance Status ; Meningioma ; Mortality ; Neurosurgical Procedures ; Petrous Bone ; Postoperative Complications ; Quality of Life ; Recurrence ; Retrospective Studies ; Survival Rate ; Telephone ; Veins

Glioblastoma multiforme (GBM) is located most frequently in the cerebral hemispheres. Glioblastoma presenting as an extraaxial mass of cerebellopontine angle (CPA) is very rare in adults. We report a rare case of GBM arising in the CPA. The patient was a 71-year-old female, who complained of progressive gait disturbance and poor memory. Initial magnetic resonance imaging (MRI) revealed a 1.4×1.3 cm mass in the left CPA, with broad base to the petrous bone, showing homogenous enhancement. Follow-up MRI showed a rapid increase in size of mass (2.7×2.2 cm) with a necrotic portion. A stereotactic biopsy was done under the guidance of navigation system, and the histopathologic diagnosis was GBM, World Heath Organization grade IV. Further surgical resection was not performed considering her general condition, and the patient underwent concurrent chemotherapy with radiation therapy. Although rare, the possibility of glioblastoma should be included in the differential diagnosis of atypical CPA tumor.
Adult ; Aged ; Biopsy ; Cerebellopontine Angle* ; Cerebrum ; Diagnosis ; Diagnosis, Differential ; Drug Therapy ; Female ; Follow-Up Studies ; Gait ; Glioblastoma* ; Humans ; Magnetic Resonance Imaging ; Memory ; Petrous Bone

Bone Neoplasms ; pathology ; Cerebellum ; pathology ; Humans ; Neurocytoma ; pathology ; Petrous Bone ; pathology

Cholesteatoma ; diagnosis ; pathology ; Humans ; Petrous Bone ; pathology

OBJECTIVES: Aim of the present study was to define the relationship between petrous apex pneumatization and the nearby major anatomical landmarks using temporal bone computed tomography (CT) images. METHODS: This retrospective, Institutional Review Board-approved study analyzed CT images of 84 patients that showed normal findings bilaterally. Pneumatization of the petrous apex was classified using two methods. Eight parameters were as follows: angle between the posterior cranial fossa and internal auditory canal, Morimitsu classification of anterior epitympanic space, distance between the carotid canal and jugular bulb, distance between the cochlear modiolus and carotid canal, distance between the tympanic segment and jugular bulb, high jugular bulb, distance between the vertical segment and jugular bulb, and distance between the lateral semicircular canals and middle cranial fossa. RESULTS: There was a significant difference in Morimitsu classification of the anterior epitympanic space between the two classification methods. Poorly pneumatic upper petrous apices were distributed uniformly in three types of Morimitsu classification, but more pneumatic upper petrous apices were found more often in anterior type. Lower petrous apex was well pneumatized regardless of the types of anterior epitympanic space, but the largest amount of pneumatization was found more frequently in the anterior type of anterior epitympanic space. CONCLUSION: This study showed that there was no reliable anatomic marker to estimate petrous apex pneumatization and suggests that the pneumatization of the petrous apex may be an independent process from other part of the temporal bone, and may not be influenced by the nearby major anatomical structures in the temporal bone. In this study, the anterior type of anterior epitympanic space was found to be closely related to more well-pneumatized petrous apices, which implies that the anterior saccule of the saccus medius may be the main factor influencing pneumatization of the petrous apex.
Classification ; Cranial Fossa, Middle ; Cranial Fossa, Posterior ; Growth and Development ; Humans ; Petrous Bone ; Retrospective Studies ; Saccule and Utricle ; Semicircular Canals ; Temporal Bone

OBJECTIVE: To explore the clinical characteristics, diagnosis method and treatment of petrous apex cholesteatoma. METHOD: A retrospective analysis was taken with respects to the clinical characteristics, diagnosis and surgical management of 38 patients who underwent surgery for petrous apex cholesteatoma in our department. RESULT: (1)31 patients had unilateral hearing loss and facial paralysis of different degree, 27 patients were firstly characterized with hearing loss, and followed by facial paralysis. 6 cases had facial paralysis as the main performance. (2)17 patients had syndrome of tinnitus, and 15 patients had syndrome of vertigo and 4 cases of severe pain of ear. (3)All patients had petrous bone destroy with high resolution CT scan, while MRI suggests the presence of pathological changes in petrous apex. (4)All patients were taken surgeries to remove the lesion, and translabyrinth approach was chosen for 23 patients, middle cranial fossa approach is 12, while 3 case has choose endoscopic approach. 8 cases were operated with facial nerve decompression. 7 cases was taken end to end anastomosis. 3 cases of great auricular nerve transplantation. There is no recurrence in follow-up of 1 years to 2 years. CONCLUSION The clinical manifestations of petrous apex cholesteatoma lack specificity, and high resolution CT and MRI has important value in the diagnosis of petrous apex cholesteatoma. The strategy of surgical operation should be taken according to the classification, location of petrous apex cholesteatoma as well as hearing level and facial nerve function with patients.
Cholesteatoma ; pathology ; surgery ; Cranial Fossa, Middle ; Decompression, Surgical ; Facial Nerve ; Facial Paralysis ; Hearing Loss ; Hearing Loss, Unilateral ; Humans ; Magnetic Resonance Imaging ; Petrous Bone ; Recurrence ; Retrospective Studies ; Tomography, X-Ray Computed

Petrous apicitis is a rare but fatal complication of otitis media. An infection within the middle ear can extend within the temporal bone into the air cells of the petrous apex. With only the thin dura mater separating the trigeminal ganglion and the 6th cranial nerve from the bony petrous apex, they are vulnerable to inflammatory processes, resulting in deep facial pain, lateral rectus muscle paralysis, and diplopia. In 1904, Gradenigo described a triad of symptoms related to petrous apicitis, including acute suppurative otitis media, deep facial pain resulting from trigeminal involvement, and abducens nerve palsy. It has traditionally been treated with surgery, but recent advances in imaging, with improved antibiotic treatment, allow conservative management. In this case report, we describe a clinical and neuroradiological evolution of a child with a petrous apicitis after acute otitis media, which was managed medically with a positive outcome.
Abducens Nerve Diseases* ; Abducens Nerve* ; Child ; Cranial Nerves ; Diplopia ; Dura Mater ; Ear, Middle ; Facial Pain ; Humans ; Muscles ; Otitis Media* ; Otitis Media, Suppurative ; Otitis* ; Paralysis ; Petrositis* ; Petrous Bone ; Temporal Bone ; Trigeminal Ganglion

OBJECTIVES: The purpose of this study was to inspect the clinical characteristics, surgical approaches, functional preservation, and complications of petrous bone cholesteatoma and to propose appropriate surgical approaches based on long-term follow-up cases and previous reports in the literature. METHODS: The medical records of 31 patients who underwent surgery for petrous bone cholesteatoma between 1990 and 2011 at two tertiary referral hospitals were retrospectively analyzed with regard to the classification, type of surgical approach, preservation of facial and auditory function, and recurrence. RESULTS: Of 31 cases, 16 were supralabyrinthine (class I), 1 was infralabyrinthine-apical (class III), 13 were massive (class IV), and 1 was apical (class V). Facial nerve palsy was found in 35.5% of the cases (11 cases). Hearing was preserved in 11 of 22 patients who had better than a 50-dB hearing level of bone conduction pure tone average preoperatively. Preoperative hearing was preserved in only four of the patients in class I (supralabyrinthine). Facial function was preserved or improved in 29 patients (93.5%). CONCLUSION: Complete removal of cholesteatoma of petrous bone can be achieved by choosing the appropriate approach based on location and extent. Facial function was preserved postoperatively in most reviewed cases. Auditory function could not be preserved postoperatively in some cases, but preserving residual hearing levels can be accomplished mostly in supralabyrinthine cholesteatomas with the appropriate surgical approach.
Bone Conduction ; Cholesteatoma* ; Classification ; Facial Nerve ; Follow-Up Studies ; Hearing* ; Humans ; Medical Records ; Paralysis ; Petrous Bone* ; Recurrence ; Retrospective Studies ; Tertiary Care Centers

OBJECTIVE: To explore the clinical characteristics, diagnosis and surgical management of petrous bone cholesteatoma. METHOD: The data of 12 patients who underwent surgery for petrous bone cholesteatoma(PBC) were retrospectively analyzed with respects to the clinical characteristics, diagnosis and management. RESULT: Seven cases were characterized by a long otitis media history, severe hearing loss, and facial paralysis. In contrast, 5 cases were characterized with the symptoms of facial paralysis, hearing loss and vertigo attack and the absence of early otorrhea history. Trans labyrinth approach was chosen for 2 cases,while trans labyrinth-cochlear approach for 10. Cochlea was involved in 10 cases, while internal auditory canal in 9 and semicircular canal in 11. Otoscope was used in 1 case. Four patients were treated by partial resection of petrous apex and ear canal closure with good results. After years of follow-up, three recurrence cases were operated for a second time. Simultaneous facial nerve anastomosis or decompression was performed. The function of facial nerve recovered from V-VI to Ill-IV (House and Brackmann grading) in 6 anastomosis cases and from IV-V to II- IlI in 3 cases of decompression. CONCLUSION Petrous bone cholesteatoma was characterized by severe hearing loss, and facial paralysis. Surgical approaches are decided according to the extent of lesion and hearing status. Our study indicated that otoscope would help to ensure a radical removal of the pathology in cases with deep involvement and restricted vision. Partial resection of petrous bone and ear canal closure could be effective solution for challenging cerebrospinal fluid otorrhea with large dural defects and protecting vital neurovascular structures.
Adolescent ; Adult ; Child ; Child, Preschool ; Cholesteatoma ; diagnosis ; pathology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Petrous Bone ; pathology ; surgery ; Retrospective Studies ; Young Adult