Abstract

Cerebral abscess is becoming a rarer complication of cholesteatoma. In this study we report a sporadic right cholesteatoma with intracranial diffusion and cerebral abscess, highlighting the innovations of the neuroimaging study, and pitfalls, tips, and tricks of its surgical management. We revised a multicentric retrospective registry of patients with complicated cholesteatomas and an exemplary case for the modern multidisciplinary management of complicated cholesteatomas is described. A 77-year-old female was admitted to our hospital for right facial nerve palsy (House-Brackmann type 4), painful irradiation of the right half face, and ipsilateral hearing loss. Neuroimaging diagnostic classification revealed right temporal cerebral abscess related to inner ear cholesteatoma with tegmen tympani erosion. Stereotaxic neuronavigational-assisted drainage of the right temporal brain abscess and microscope-assisted radical mastoidectomy and epitympano-mastoid cholesteatoma exeresis were performed. A regular clinical and radiological follow-up demonstrated regression of the facial nerve palsy and aesthetic improvement, complete reclamation of the cerebral abscess cavity without signs of residual parenchymal inflammation, and total removal of the cholesteatoma in the absence of disease recovery. Preoperative treatment with new generations of antibiotics and lesion studies with advanced neuroimaging techniques have renewed the diagnostic and therapeutic approach to massive intracranial complicated cholesteatoma. The multidisciplinary planning, the choice of the appropriate surgical approach, and the microscopicassisted dissection are mandatory for a disease-safe removal, abating the risk of surgical complications and pathology recurrences.

Keywords: Cholesteatoma; Epidural abscess; Microsurgery; Magnetic resonance imaging; Otologic surgical procedures