Primary Petrous Apex Epidermoids With Skull Base Erosion. Issue 5 (June 2019)

• Record Type: Journal Article
• Authors: Casazza, Geoffrey C.; McCrary, Hilary C.; Shelton, Clough; Gurgel, Richard K.
• Is Part Of: Otology & neurotology. Volume 40:Issue 5(2019)
• Publication Date: 2019-06
• Subjects: Epidermoid cyst -- Epidermoid -- Petrous apex; Otology -- Periodicals; Ear -- Diseases -- Periodicals; Skull base -- Surgery -- Periodicals; 617.8005
• DOI: 10.1097/MAO.0000000000002199
• Languages: English
• ISSNs: 1531-7129

Abstract

Abstract : Objective: To describe the clinical course and treatment outcomes for patients with petrous apex epidermoid with skull base erosion. Study Design: Retrospective case series. Setting: Tertiary-care academic center. Patients: Patients surgically managed for petrous apex epidermoids at a single-tertiary care institution from 2001 to 2017. Interventions: Surgical management of primary petrous apex epidermoids. Main Outcome Measures: The presenting symptoms, imaging, pre- and postoperative clinical course, and complications were reviewed. Results: Seven patients were identified. The most common presenting symptoms included: sudden sensorineural hearing loss (n = 3), headaches (n = 1), vertigo (n = 2), and facial paralysis/paresis (n = 2). An epidermoid was discovered in two patients as an incidental finding after a head trauma and one patient after admission for altered mental status and meningitis. Two patients presented with complete facial paralysis (House–Brackmann 6/6). Preoperative normal hearing (pure-tone average < 25 db) was identified in three patients and serviceable hearing (pure-tone average 25–60 dB) in one patient. Three patients with nonserviceable hearing underwent a transcochlear or transotic approach. The remaining four patients underwent an attempted hearing preservation approach. Postoperatively, one patient developed delayed facial paralysis, improving within 3 months. Hearing was preserved in three patients. Two patients developed recurrence of disease within 4 and 7 years respectively. Conclusions: Surgical management of aggressive petrous apex epidermoid is effective to preserve facial function and prevent recurrence. In our series different surgical approaches were used with variable outcomes.