2025 Poster Presentations
P349: ENDOSCOPIC APPROACH TO TUMORS OF THE PETROUS APEX, 10 YEARS OF EXPERIENCE
Ignacio Cifuentes, MD1; Fernanda De Amesti, MD1; Francisco Ringler2; Katherine Walker2; Homero Sariego2; Matías Gómez, MD2; 1Universidad de Chile; 2Instituto de Neurocirugía Dr. Asenjo
The petrous apex corresponds to a portion of the temporal bone, which has a pyramidal shape and is related to multiple structures which can be affected by the presence of tumors or by their surgical resection. Its surgical access is difficult and challenging. In this experience, we present the case series of patients diagnosed with tumors of the petrous apex, who underwent nasal endoscopic surgery for resolution at Neurosurgery Institute Dr. Asenjo (INCA) in Santiago de Chile between the years 2013-2023.
Objectives:
General: Describe the management of patients who underwent endoscopic resolution for petrous apex tumors at INCA by the otolaryngology and/or neurosurgery team during the specified period.
Secondary Objectives:
Describe epidemiological aspects of the included patients.
Summarize clinical manifestations and the study population.
Describe surgical alternatives employed for petrous apex tumors resection.
Describe and analyze results of this surgery, in terms of complete resection rate, recurrence rate, postoperative discomfort and follow-up.
Inclusion Criteria:
Patients aged 0-99 years.
Surgery performed by the otolaryngology and neurosurgery team between 2013-2023 at INCA.
Exclusion Criteria:
Incomplete records in physical/electronic files for data analysis.
Open surgical approach for tumor resection.
During the time period studied, a total of 9 nasal endoscopic surgeries were performed for the management of patients with petrosal apex tumors. Of the total patients included in the sample, the average age at the time of surgery was 42.5 years, with an age range between 7 and 73 years, there were 5 female patients (56%).
Among the clinical manifestations, there were 4 (44%) cases of headache, 3 (33%) cases of unilateral hearing loss, 2 (22%) cases of involvement of the sixth cranial nerve, 2 (22%) patients with facial paralysis, and in 4 (44%) patients the diagnosis was made incidentally when studying patients with radiological examinations for other causes. All patients were studied with magnetic resonance imaging of the brain and computed tomography of the paranasal cavities prior to surgery.
In terms of management, endoscopic surgery was performed in all patients included in the sample, where the technique in 8 (88%) of the cases was transsphenoidal, while in 1 (12%) case it an associated transsphenoidal to trasnpterygoid approach. In all surgeries, a biopsy of the tumor was performed to make a histological diagnosis, finding 3 (33%) cases of cholesterol granuloma, 1 (11%) case of mucocele of the petrous apex, 1 (11%) case of cholesteatoma, 1 (11%) case of chondrosarcoma, 1 (11%) case of metastasis to the petrous apex, 1 (11%) case of Langerhaans Histiocytosis and 1 (11%) case of exocrine pancreatic tissue.
Describing the results of the surgeries, during follow-up, recurrence of the operated lesion was recorded in 2 (22%) patients. Postoperative complications occurred in 3 (33%) patients, with 2 cases of cerebrospinal fluid fistulas that were repaired in a second surgery, and one case of meningitis that required intravenous antibiotic management.