Circumferential petrosectomy for petrous apicitis and cranial base osteomyelitis

Ann Marie B Visosky, Brandon Isaacson, John S. Oghalai

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

OBJECTIVE: Petrous apicitis and cranial base osteomyelitis are life-threatening conditions. A surgical management may be necessary in cases that progress, in conditions that fail to improve with medical treatment, or in cases with impending complications. In this study, we describe a technique to remove the maximum amount of infected temporal bone while preserving the integrity of the peripheral auditory pathway and facial nerve. STUDY DESIGN: Retrospective study. SETTING: Tertiary referral hospital. PATIENTS: Five patients with impending complications, whose disease progressed or whose conditions failed to improve while on culture-directed antibiotics underwent circumferential petrosectomy. INTERVENTIONS: The circumferential petrosectomy removes most of the temporal bone around the external, middle, and inner ear. A combined retrolabyrinthine-apical petrosectomy is performed in conjunction with the fallopian bridge technique using a transmastoid and middle cranial fossa approach. A split temporalis muscle flap is used to bring vascularized tissue to the mastoid, jugular foramen, and petrous apex. MAIN OUTCOME MEASURES: Disease resolution, change in hearing or facial nerve function, complications. RESULTS: Each of the five patients had modifications to the procedure tailored to their disease extent: three had disease primarily involving the petrous apex and two had disease adjacent to the jugular foramen. Additional cultures of the infected bone were obtained during surgery. A culture-directed antibiotic theraphy (duration, 6-10 weeks) was administered after surgery, which resulted in the complete resolution of the disease and the associated symptoms in all five patients. No patient experienced hearing loss or facial nerve dysfunction as a result of the surgery within at least 1 year of follow-up in four of the five patients in this series. CONCLUSION: The circumferential petrosectomy is a potential treatment option when medical treatment fails in patients with petrositis or cranial base osteomyelitis. It permits maximal temporal bone debridement while preserving hearing and facial nerve integrity in these life-threatening disease processes.

Original languageEnglish (US)
Pages (from-to)1003-1013
Number of pages11
JournalOtology and Neurotology
Volume27
Issue number7
DOIs
StatePublished - Oct 2006

Fingerprint

Petrositis
Skull Base
Osteomyelitis
Facial Nerve
Temporal Bone
Hearing
Neck
Middle Cranial Fossa
Anti-Bacterial Agents
External Ear
Auditory Pathways
Cochlear Nerve
Mastoid
Middle Ear
Inner Ear
Debridement
Hearing Loss
Tertiary Care Centers
Therapeutics
Retrospective Studies

Keywords

  • Cranial base surgery
  • Gradenigo's syndrome
  • Osteomyelitis
  • Petrous apex
  • Petrous apicitis
  • Skull base

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Neuroscience(all)

Cite this

Circumferential petrosectomy for petrous apicitis and cranial base osteomyelitis. / Visosky, Ann Marie B; Isaacson, Brandon; Oghalai, John S.

In: Otology and Neurotology, Vol. 27, No. 7, 10.2006, p. 1003-1013.

Research output: Contribution to journalArticle

Visosky, Ann Marie B ; Isaacson, Brandon ; Oghalai, John S. / Circumferential petrosectomy for petrous apicitis and cranial base osteomyelitis. In: Otology and Neurotology. 2006 ; Vol. 27, No. 7. pp. 1003-1013.
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