Endoscopic transnasal removal of cholesteatomas of the temporal bone pyramid with extension to the clivus

Abstract

Background: Cholesteatomas of the temporal bone pyramid can invade the clivus through the petrous apex. As these cases are extremely scarce in world literature, an optimal approach to their treatment has not been determined. Methods: We present two clinical cases: a patient with an apical cholesteatoma of the temporal bone pyramid extending to the clivus and a patient with a massive cholesteatoma of the temporal bone pyramid, also extending to the clivus according to the classification proposed by Sanna. Results: The apical cholesteatoma was removed totally, while the massive cholesteatoma was subjected to subtotal removal. In the second case, the duration of postoperative hospital stay was 7 days, while in the first case, hospitalization time was extended to 12 days as a result of postoperative cerebrospinal fluid leakage (due to intraoperative dura mater damage during the removal of the cyst capsule) and consequent revision duraplasty, further substantiating the need for the most delicate separation of the tumor capsule from the underlying dura mater. Conclusion: As a result of the development of modern endoscopic endonasal technologies in skull base surgery, effective removal of cholesteatomas of temporal bone pyramid with extension to the clivus has become possible using minimally invasive and organ-saving methods.

Keywords

• Transnasal endoscopic approach
• Cholesteatoma