Infralabyrinthine petrous bone cholesteatoma (literature review)

Abstract

A literature review on the infralabyrinthine petrous bone cholesteatoma (PBC) was presented in this article. Attention is paid to etiology and clinical symptoms of the disease, classifications. All modern classifications divide cholesteatoma with localization under the labyrinth into two big groups: infralabyrinthine and infralabyrinthine apical. This is not enough to determine the algorithm of surgical tactic of these patients. The most used approaches to the infrlabyrinyhine area and lateral skull base were analyzed (infralabyrinthine and infracochlear, subtotal petrosectomy, transotic approach, group of transcochlear approaches, infratemporal and translabyrinthine approaches). Possible variants of the surgery ending are described (tympanoplasty or “cul-de-sac” closure). Comparison of the results of different authors, starting from 1990, in which the infralabyrinthine cholesteatoma was distinguished as a separate class was carried out. 16 publications were analyzed based on the type of used classification, the total number of cases with infralabyrinthine cholesteatoma, the type of surgical approach, the complications and recurrence rate. The total number of patients was 141, 84 with infralabyrinthine (59,6%), 57 (40,4%) with infralabyrinthine apical PBC. The most common type of surgery were subtotal petrosectomy, transcochlear approach in different variations and transotic approach. The recurrence rate ranged from 0 to 29%. This paper identifies unresolved issues, the necessity of new classification and algorithm of surgical management based on it.