Primary Petrous Apex Epidermoids With Skull Base Erosion.

OBJECTIVE

To describe the clinical course and treatment outcomes for patients with petrous apex epidermoid with skull base erosion.

STUDY

DESIGN

Retrospective case series.

SETTING

Tertiary-care academic center.

PATIENTS: Patients surgically managed for petrous apex epidermoids at a single-tertiary care institution from 2001 to 2017.

INTERVENTIONS: Surgical management of primary petrous apex epidermoids.

MAIN OUTCOME MEASURES: The presenting symptoms, imaging, pre- and postoperative clinical course, and complications were reviewed.

RESULTS

Seven patients were identified. The most common presenting symptoms included: sudden sensorineural hearing loss (n = 3), headaches (n = 1), vertigo (n = 2), and facial paralysis/paresis (n = 2). An epidermoid was discovered in two patients as an incidental finding after a head trauma and one patient after admission for altered mental status and meningitis. Two patients presented with complete facial paralysis (House-Brackmann 6/6). Preoperative normal hearing (pure-tone average < 25 db) was identified in three patients and serviceable hearing (pure-tone average 25-60 dB) in one patient. Three patients with nonserviceable hearing underwent a transcochlear or transotic approach. The remaining four patients underwent an attempted hearing preservation approach. Postoperatively, one patient developed delayed facial paralysis, improving within 3 months. Hearing was preserved in three patients. Two patients developed recurrence of disease within 4 and 7 years respectively.

CONCLUSIONS

Surgical management of aggressive petrous apex epidermoid is effective to preserve facial function and prevent recurrence. In our series different surgical approaches were used with variable outcomes.