Primary Petrous Apex Epidermoids With Skull Base Erosion.

Objective: To describe the clinical course and treatment outcomes for patients with petrous apex epidermoid with skull base erosion.
Study Design: Retrospective case series.
Setting: Tertiary-care academic center.
Patients: Patients surgically managed for petrous apex epidermoids at a single-tertiary care institution from 2001 to 2017.
Interventions: Surgical management of primary petrous apex epidermoids.
Main Outcome Measures: The presenting symptoms, imaging, pre- and postoperative clinical course, and complications were reviewed.
Results: Seven patients were identified. The most common presenting symptoms included: sudden sensorineural hearing loss (n = 3), headaches (n = 1), vertigo (n = 2), and facial paralysis/paresis (n = 2). An epidermoid was discovered in two patients as an incidental finding after a head trauma and one patient after admission for altered mental status and meningitis. Two patients presented with complete facial paralysis (House-Brackmann 6/6). Preoperative normal hearing (pure-tone average < 25 db) was identified in three patients and serviceable hearing (pure-tone average 25-60 dB) in one patient. Three patients with nonserviceable hearing underwent a transcochlear or transotic approach. The remaining four patients underwent an attempted hearing preservation approach. Postoperatively, one patient developed delayed facial paralysis, improving within 3 months. Hearing was preserved in three patients. Two patients developed recurrence of disease within 4 and 7 years respectively.
Conclusions: Surgical management of aggressive petrous apex epidermoid is effective to preserve facial function and prevent recurrence. In our series different surgical approaches were used with variable outcomes.