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The role of subtotal petrosectomy in cochlear implant surgery: Report of 61 cases and review on
Lauda L. , Medina M. , Falcioni M. , De Donato G. , Free R.H. , Guida M. , Sanna M.
Gruppo Otologico, Piacenza, Italy, 2Department of Otorhinolaryngology-Head and Neck Surgery, Cochlear Implant Center Northern
Netherlands, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
Introduction: Subtotal petrosectomy (SP) in association to cochlear implantation (CI) was first described for
cases with chronic otitis media or in the presence of a previous radical cavity. It has also been used in cases of
cochlear malformations, and as a salvage procedure for repeating meningitis. The aim of this surgical technique
is to create an environment with less risk of infection and higher possibilities for sealing off any CSF leakage. In
addition, it provides a better access and visibility during surgery.
Objective: To report and review 61 cases of subtotal petrosectomy (SP) in cochlear implant (CI) surgery and to
define the indications and contraindications for this procedure
Material and methods: Retrospective case review undertaken in a terciary referral skull base center. The
database of CIs performed in our Department from 2004 to 2013 contained 60 patients treated. The surgical
technique consisted on subtotal petrosectomy with blind sac closure of the external auditory canal, closure of
Eustachian tube, and abdominal fat obliteration in combination with cochlear implantation. All patients were
scheduled for a control CT scan at 1, 3, 5, and 10 years to monitor the development of residual cholesteatoma in
the obliterated cavity.
Results: Indications for SP in CI surgery were the following: chronic otitis media (n = 12), previous radical cavity
(n = 18), previous subtotal petrosectomy (n = 6), ossification of the cochlea (n = 7), malformation of the inner ear
(n = 4), temporal bone fracture (n = 5), combined skull base approach (n=9). One patient was simultaneously
bilaterally implanted; two cases were revisions. All procedures were performed in one stage. In five cases
(8.6%), complications were encountered (one subcutaneous cerebrospinal fluid collection, two array extrusions,
one temporal lobe abscess and one abdominal fat infection). Only in one case the complication was related to
the SP procedure. None of them needed explantation. No cholesteatoma has been found in this population until
now. Mean follow-up was 52 months (range 8 - 113 months).
Conclusion: Subtotal petrosectomy combined with cochlear implantation is a procedure required in specific
situations and lowers the risk of repetitive ear infections, CSF leakage and meningitis by eliminating all
connection with the external environment. Additionally, it gives excellent visibility and access in difficult anatomy
or in drill-out procedures. Preservation of residual hearing can be considered the only absolute contraindication
as an open external meatus is necessary for use of electroacoustic stimulation.
Additional risks of the combined SP + CI procedure are infection of the abdominal fat, breakdown of the blind sac
closure, and entrapped cholesteatoma.