• Zhen Gao, Wen-Long Tang, Zhao-Jun Qin, Wei-Dong Zhao, Chun-Fu Dai, Fang-Lu Chi, and Ya-Sheng Yuan.
• Department of Otology and Skull Base Surgery, Eye and ENT Hospital, Fudan University, Shanghai, People's Republic of China; NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, People's Republic of China.
• World Neurosurg. 2020 Nov 1; 143: 84-90.

ObjectiveMicrosurgery is the reference standard treatment of petrous bone cholesteatoma (PBC). In most cases, radical removal of an extensive PBC can only be achieved at the cost of sacrificing the cochlea. Such treatment will result in the impossibility of future cochlear implantation for hearing rehabilitation purposes. To address this issue, a modification of the traditional translabyrinthine (TL) approach with endoscopic assistance has been developed for radical removal of extensive PBC with preservation of the cochlea.MethodsFrom June 2017 to December 2017, 3 patients with a massive PBC underwent surgical removal using the modified TL approach by the senior author in our department. We reviewed the patient characteristics and retrospectively studied the surgical outcomes and postoperative complications. In the present report, we have described our modified TL approach in detail.ResultsComplete resection of the PBC and successful cochlea preservation were achieved in all 3 patients. No recurrence had developed during the follow-up period. However, various degrees of cochlear ossification were observed in 2 patients postoperatively.ConclusionsThis modified TL approach provides the possibility of fully exposing the whole petrous apex without removing the cochlea in selected cases. However, the development of long-term cochlear ossification requires further investigation to allow for successful cochlear implantation.Copyright © 2020 Elsevier Inc. All rights reserved.

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