Effectiveness of Diffuse Laser Energy in the Treatment of Cholesteatoma Adherent to Dura: Laser for Dura-Adherent Cholesteatoma.

INTRODUCTION AND

OBJECTIVE

Cholesteatoma can expose and become adherent to dura. It may be difficult to remove using conventional instruments. We describe a technique to denature the cholesteatoma so that it is eliminated without opening the intracranial space. We quantify the effectiveness and complications of the procedure using a retrospective cohort study (evidence level IV).

PATIENTS: Patients with cholesteatoma that had exposed and become adherent to dura mater. Patient records retrieved from secondary care surgical database using fields designed for the purpose.

PROCEDURE: Diffuse laser energy was used to slowly warm and denature the cholesteatoma in situ. The procedure did not require excision of disease. The dura was always reinforced with a thin fibro-fatty graft.

MAIN OUTCOME MEASURES: Residual disease rate was assessed using second-stage surgery or non-EPI diffusion weighted MR scans. Acute dural perforation rate, chronic cerebrospinal fluid leak, and intracranial infection rate were also measured.

RESULTS

Forty-six ears were included. Forty-four of the 46 cases underwent assessment for residual cholesteatoma with second-stage surgery or non-EPI diffusion-weighted MR scanning. There was no locally residual cholesteatoma in any of the 44 cases that were assessed. Eight cases (17%) involved dural perforation during surgery. The patients that had dural perforation were discernibly older than those whose dura remained intact ( P <0.05). There were no postoperative CSF fistulas or cases with intracranial infection.

CONCLUSIONS

Cholesteatoma that is firmly adherent to dura can be eliminated by slow heating of the cholesteatoma with diffuse laser energy without loss of dural integrity in 80% cases. Treatment involves more than laser treatment and 20% cases were associated with dural perforation during treatment. Older patients are at greater risk than younger patients for this complication of treatment. There were no cases of chronic CSF fistula and no cases of intracranial infection.