Cholesterol granulomas of the petrous apex: combined neurosurgical and otological management.
Cholesterol granulomas of the petrous apex: combined neurosurgical and otological management.
复制标题
岩尖胆固醇肉芽肿：神经外科和耳科联合治疗。
DOI：
10.3171/jns.1996.85.4.0625
复制
发表时间：
1996
影响因子：
4.1
通讯作者：
G. Gardner
中科院分区：
文献类型：
--
作者：
J. A. Brodkey;J. Robertson;J. Shea;G. Gardner
头部的胆固醇肉芽肿相对罕见。小脑脑桥角的孤立性病变更为少见。本文报告17例岩尖胆固醇肉芽肿，并讨论其治疗方法。出现的症状包括头晕14名患者中，有9名患者出现耳鸣，8名患者出现听力丧失，6名患者出现耳痛，6名患者出现头痛，3名患者出现恶心，2名患者出现耳外引流，2名患者出现面部疼痛，2名患者出现癫痫发作，1名患者出现头晕，1名患者出现面肌痉挛，1名患者出现面部麻木。6例患者行非手术治疗，11例患者行手术治疗。使用的方法包括下丘脑（8例患者），经鼻-下丘脑（2例患者）和经丘脑（1例患者）。所有病例的平均随访时间为29.5个月。在那些没有手术的患者中，除了一名耳鸣稍微严重外，所有患者的症状都有所改善。手术治疗的患者，症状改善或保持不变，除了一个加重头晕。术前有听力者9例，术后听力保留者7例。作者介绍了一例在另一家临床试验机构接受治疗的病例，该中心尝试通过颞下中颅窝入路进行手术切除，但未成功。采用乳突下入路并引流至乳突腔成功治疗了该病变。当症状稳定或改善时，岩尖胆固醇肉芽肿可以不经手术治疗。否则，经乳突硬膜外入路，简单引流至乳突窦或中耳，可改善症状，发病率低。岩尖胆固醇肉芽肿不需要切除。
Cholesterol granulomas of the head are relatively rare. Isolated lesions of the cerebellopontine angle are even more uncommon. In this report, 17 cases of petrous apex cholesterol granulomas are presented and management is discussed. Symptoms at presentation included dizziness (14 patients), pressure (nine patients), tinnitus (eight patients), hearing loss (eight patients), otalgia (six patients), headache (six patients), nausea (three patients), drainage from ear (two patients), facial pain (two patients), seizure (two patients), lightheadedness (one patient), hemifacial spasm (one patient), and facial numbness (one patient). Six cases were managed without surgery and 11 patients underwent operative procedures. The approaches used included the infralabyrinthine (eight patients), transcanal-infracochlear (two patients), and translabyrinthine (one patient). The mean follow-up period for all cases was 29.5 months. Of those patients managed without surgery, symptoms improved in all except one, whose tinnitus was slightly worse. Of surgically treated patients, symptoms improved or remained the same except in one with worsened dizziness. There were nine patients with hearing present presurgery and seven whose hearing was preserved postsurgery. The authors present a case that was managed at another center where an attempt at surgical resection through a subtemporal middle fossa approach was unsuccessful. This lesion was successfully treated using an infralabyrinthine approach with drainage into the mastoid cavity. Cholesterol granulomas of the petrous apex can be managed without surgery when symptoms are stable or improve. Otherwise, a transmastoid extradural approach with simple drainage into the mastoid sinus or middle ear produces symptomatic improvement with low morbidity. Resection of petrous apex cholesterol granulomas is not necessary.