SUBTOTAL PETROSECTOMY IN MIDDLE-EAR AND LATERAL SKULL-BASE SURGERY

Filippo Di Lella, Maurizio Falcioni

Gruppo Otologico, Piacenza-Roma, Italy

The aim of lateral or subtotal petrosectomy (STP) is to eliminate the middle ear space in order to obtain a regular bony cavity filled with abdominal fat devoid of exposure to the external environment. It involves a double-layer closure of the external auditory canal, a canal-wall-down mastoidectomy with resection of tympanic and ossicular chain remnants and lowering of the facial nerve ridge and Eustachian tube occlusion. The cavity thus created is finally packed with free abdominal fat graft. This procedure has been initially described and used by Fisch since 1988 and was primarily addressed to radically treat pluri-operated discharging ears with compromised hearing.

While adding little or none adjunctive risks for the patients, STP gives definitive advantages in terms of surgical exposure and anatomic control with easy identification of surgical landmarks. In the light of the excellent curative and anatomic long-term results, the subtotal petrosectomy has been adopted for many conditions requiring obliteration of the tympanomastoid system, like temporal bone meningo-encephaloceles, petrous bone fracture with CSF leak and cochlear implantation in complex or unfavorable cases (i.e., malformations, revision surgery, cochlear ossification). STP is also part of skull base surgery basic skills because it may constitute the initial part of a transtemporal (transotic and transcochlear approaches) or combined approach (infratemporal fossa type A and B approaches) in the treatment of skull base lesions. When performing a lateral skull base procedure, STP must be included if a simultaneous cochlear implantation is considered in the pre-operative planning.

The advent of active middle ear implants and bone anchored hearing aids allows for simultaneous or staged hearing rehabilitation in patient undergoing this procedure, if the bone conduction is maintained. This facilitates both the patients and the clinician in the choice of treatment.

The Gruppo Otologico indications for subtotal petrosectomy will be reported, with particular focus on pre-operative clinical and radiologic evaluation, intra-operative technical details, rehabilitation and short- and long-term complications and results. Strategy for radiologic surveillance will also be reported.


Address for correspondence: Filippo Di Lella, MD-PhD, Gruppo Otologico, Casa di Cura Piacenza, Via Emmanueli 42 29121, Piacenza, Italia. flippo.dilella@gruppootologico.it

Cholesteatoma and Ear Surgery – An Update, p. 161

Edited by Haruo Takahashi

2013 © Kugler Publications, Amsterdam, The Netherlands