Petrous bone cholesteatoma: A deceiving entity. Diagnosis, classification and management

Petrous bone cholesteatoma are rare and account for 3–9% of all cholesteatomas. Hearing loss, chronic otorrhea, vestibular symptoms or peripheric facial palsy are common and may be the presenting symptom. Its treatment is surgical and it is very challenging as the lesion may invade important structures: internal carotid artery, jugular vein, facial nerve or otic capsule. characterize the petrous bone cholesteatomas treated, its classification and surgical management. Retrospective analysis of all petrous bone cholesteatomas from Jan 2021 to June 2023. A total of seven patients (4 males, 3 females) were identified with petrous bone cholesteatomas, with hearing loss present in all at the diagnosis. Four of the patients had at least one previous surgery. Four cases were supralabyrinthine, two were infralabyrinthine and one was classified as massive. Six patients were treated with surgery. In four cases a subtotal petrosectomy was performed, in one case the excision was performed through a middle fossa approach and in one case a combined approach with microscope and endoscope was performed. Facial nerve function was not impaired by surgery as its function did not get worse following surgery. In one patient improved hearing was observed. Complete lesion eradication was possible in five of the cases. Post operative complications occurred in three patients. Clinical presentation of petrous bone cholesteatoma can be quite innocent even with the invasion of important structures Its treatment is surgically complex and the morbidity is high.