颞下窝进路TypeB技术在颞骨岩部胆脂瘤治疗中的应用

Application of infratemporal fossa type B approach in the treatment of petrous bone cholesteatoma

目的探讨颞下窝径路Type B技术在颞骨岩部巨大迷路型胆脂瘤切除中的临床应用价值。方法回顾性分析2015年8月～2017年4月北京协和医院耳鼻咽喉科收治的5例巨大迷路型颞骨岩部胆脂瘤患者的临床资料,5例患者中曾行开放式乳突根治1例,岩骨次全切除(保留听囊) 1例,开放式乳突根治后再行岩骨次全切除(保留听囊) 1例,入院后5例患者均接受颞下窝径路Type B手术切除。结果 5例患者均手术完整切除,显微镜下术腔无死角,检查无胆脂瘤残留。所有患者颈内动脉均有不同程度胆脂瘤包绕,均沿胆脂瘤基质与颈内动脉壁的间隙分离干净。术后均行MR+DWI随诊1～2. 5年,未见复发。5例患者术后术侧均全聋。1例面神经完整者术后H-B II级; 2例舌下神经-面神经吻合患者,其中1例术后1年H-B III级,另1例术后随访1年H-B IV级;2例头痛患者术后症状均消失。5例患者术后1个月均可正常饮食。结论颞下窝径路Type B技术可以安全、彻底切除复杂的巨大迷路型岩部胆脂瘤,未引起严重并发症。但早期反复手术失败影响对相关功能的保留和重建。

Objective To investigate the clinical application value of infratemporal fossa type B approach in the surgical treatment of giant petrous bone cholesteatoma.MethodsClinical data of 5 patients suffering from giant labyrinthine petrous bone cholesteatoma surgically treated in the Department of Otolaryngology, Peking Union Hospital from August 2015 to April 2017 were analyzed retrospectively. Of them, one patient had been previously treated with open radical mastoidectomy, one with subtotal petrosectomy (otic capsule preservation), and another one with subtotal petrosectomy after open radical mastoidectomy, respectively. All 5 patients underwent surgical removal of giant petrous bone cholesteatoma via infratemporal fossa type B approach.ResultsCholesteatoma was removed radically in all 5 cases. Intraoperative microscopy revealed neither residual cholesteatoma nor blind angle. In all cases, the internal carotid arteries were surrounded by cholesteatoma in varying degrees, and separated carefully along the space between cholesteatoma matrix and internal carotid artery wall. All patients had been followed up by MR+DWI for 12 to 30 months postoperatively without recurrence of cholesteatoma. Postoperative profound hearing loss occurred in the operative ears of all the patients. The facial nerve function was HouseBrackmann (HB) grade Ⅱ in one patient whose facial nerve was preserved completely. In 2 patients with hypoglossalfacial nerve anastomosis, the facial nerve function one year after surgery was H-B grade Ⅲ and Ⅳ respectively. All patients had normal diet one month after.ConclusionsGiant labyrinthine petrous bone cholesteatoma can be removed safely and completely via infratemporal fossa type B approach without no serious complications. Failures of repeated previous surgeries may affect the preservation and reconstruction of related functions.