medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2020-16-140-149medsovet-5859Research ArticleДИССЕРТАНТDISSERTANTИнфралабиринтная холестеатома пирамиды височной кости (обзор литературы)Infralabyrinthine petrous bone cholesteatoma (literature review)https://orcid.org/0000-0001-5337-3239ДиабХ. М.DiabK. M.

Диаб Хассан Мохамад Али, доктор медицинских наук, заместитель директора по международным отношениям, Федеральное государственное бюджетное учреждение «Научно-клинический центр оториноларингологии» Федерального медико-биологического агентства России; профессор кафедры оториноларингологии дополнительного постдипломного образования, Федеральное государственное автономное образовательное учреждение высшего образования «Российский национальный исследовательский медицинский университет имени Н.И.  Пирогова» Министерства здравоохранения Российской Федерации

123182, Москва, Волоколамское шоссе, д. 30, корп. 2, 

117197, Москва, ул. Островитянова, д. 1

Khassan M. Diab, Dr. of Sci. (Med.), Deputy Director of International Relations, Federal State Budgetary Institution “Scientific and Clinical Center of Otorhinolaryngology of the Federal Medico-Biological Agency of the Russian Federation”; Professor of Otorhinolaryngology Department of Further Postgraduate Education, Federal State Autonomous Educational Institution of Higher Education “Pirogov Russian National Research Medical University” of the Ministry of Health of the Russian Federation

30, Bldg. 2, Volokolamskoe Shosse, Moscow, 123182, 

1, Ostrovityanov St., Moscow, 117997

hasandiab@mail.ruhttps://orcid.org/0000-0002-5177-4255ПанинаО. С.PaninaO. S.

Панина Ольга Сергеевна, сотрудник научно-клинического отдела заболеваний уха и основания черепа

123182, Москва, Волоколамское шоссе, д. 30, корп. 2

Olga S. Panina, researcher of Clinical Research Department of Diseases of the Ear and Skull Base

30, Bldg. 2, Volokolamskoe Shosse, Moscow, 123182

dr.panina@gmail.comhttps://orcid.org/0000-0002-7188-3280ПащининаО. А.PashchininaO. A.

Пащинина Ольга Александровна, кандидат медицинских наук, руководитель оториноларингологического отдела заболеваний уха и основания черепа

123182, Москва, Волоколамское шоссе, д. 30, корп. 2

Olga A. Pashchinina, Cand. of Sci. (Med.), branch manager of Clinical Research Department of Diseases of the Ear and Skull Base

30, Bldg. 2, Volokolamskoe Shosse, Moscow, 123182

OlgaP83@mail.ruНациональный медицинский исследовательский центр оториноларингологии; Российский национальный исследовательский медицинский университет им. Н.И. ПироговаРоссияScientific and Clinical Center of Otorhinolaryngology; Pirogov Russian National Research Medical UniversityRussian FederationНациональный медицинский исследовательский центр оториноларингологииРоссияScientific and Clinical Center of OtorhinolaryngologyRussian Federation202013112020016140149Copyright © Диаб Х.М., Панина О.С., Пащинина О.А., 20202020Диаб Х.М., Панина О.С., Пащинина О.А.Diab K.M., Panina O.S., Pashchinina O.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/5859

В данной статье проведен анализ литературы, посвященной холестеатоме пирамиды височной кости с инфралабиринтным распространением. Уделено внимание этиологии и клинической картине заболевания, рассмотрены существующие классификации. Все  современные классификации делят холестеатому, располагающуюся под лабиринтом, на две большие группы: инфралабиринтную и инфралабиринтную апикальную, что недостаточно для определения алгоритма выбора хирургической тактики. Детально разобраны наиболее используемые хирургические доступы к инфралабиринтной области и латеральному основанию черепа (инфралабиринтный и инфракохлеарный, субтотальная петрозэктомия, доступ с сохранением лицевого нерва в костном мостике, группа транскохлеарных доступов, инфратемпоральные и транслабиринтный доступы). Описаны возможные варианты завершения операции (тимпанопластика или закрытие наружного слухового прохода наглухо). Выполнено сравнение результатов работ разных авторов начиная с 1990 г., в которых инфралабиринтная холестеатома была выделена как отдельный класс. Всего было проанализировано 16 публикаций, исходя из типа использованной классификации, общего количества случаев с инфралабиринтным вариантом распространения холестеатомы, типа хирургического доступа, выявленных осложнений и частоты рецидивирования. Общее количество пациентов составило 141 человек, у 84 из которых была инфралабиринтная (59,6%), у 57 (40,4%) – инфралабиринтная апикальная холестеатома. Наиболее частыми вариантами операции были субтотальная петрозэктомия, транскохлеарный доступ в разных вариациях и transotic approach. Уровень рецидивирования составил от 0 до 29%. В данной работе определены требующие внимания нерешенные вопросы, целесообразность разработки новой классификации инфралабиринтной холестеатомы и алгоритма хирургического лечения.

A literature review on the infralabyrinthine petrous bone cholesteatoma (PBC) was presented in this article. Attention is paid to etiology and clinical symptoms of the disease, classifications. All modern classifications divide cholesteatoma with localization under the labyrinth into two big groups: infralabyrinthine and infralabyrinthine apical. This is not enough to determine the algorithm of surgical tactic of these patients. The most used approaches to the infrlabyrinyhine area and lateral skull base were analyzed (infralabyrinthine and infracochlear, subtotal petrosectomy, transotic approach, group of transcochlear approaches, infratemporal and translabyrinthine approaches). Possible variants of the surgery ending are described (tympanoplasty or “cul-de-sac” closure). Comparison of the results of different authors, starting from 1990, in which the infralabyrinthine cholesteatoma was distinguished as a separate class was carried out. 16 publications were analyzed based on the type of used classification, the total number of cases with infralabyrinthine cholesteatoma, the type of surgical approach, the complications and recurrence rate. The total number of patients was 141, 84 with infralabyrinthine (59,6%), 57 (40,4%) with infralabyrinthine apical PBC. The most common type of surgery were subtotal petrosectomy, transcochlear approach in different variations and transotic approach. The recurrence rate ranged from 0 to 29%. This paper identifies unresolved issues, the necessity of new classification and algorithm of surgical management based on it.

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The authors declare that there are no conflicts of interest present.