Non-EPI DW MRI in planning the surgical approach to primary and recurrent cholesteatoma.

Abstract

OBJECTIVE:

To investigate a correlation between preoperative non-echo planar diffusion-weighted magnetic resonance imaging (non-EPI DW MRI) with surgical findings of localization and extension of cholesteatoma and to develop criteria for surgical planning.

PATIENTS:

Preoperative non-EPI DWMRI was available and positive for cholesteatoma in 27 patients with primary and 23 with residual/recurrent lesions.

INTERVENTIONS:

Patients with cholesteatoma limited to the middle ear and its extensions were managed with a transcanal endoscopic approach. Patients with extension of the cholesteatoma posteriorly to the lateral semicircular canal underwent retroauricular mastoidectomy combined with an endoscopic approach.

MAIN OUTCOME MEASURE:

Comparison of preoperative radiologic to surgical findings.

RESULTS:

DWI showed isolated tympanic and attic extension in 33 cases and attico-antral and mastoid extension in 17 cases. MRI findings correlated with surgical findings in all patients with primary cholesteatoma, 19 of whom were managed with a transcanal endoscopic approach and 8 with endoscope-assisted ear surgery. The transcanal endoscopic approach was applied in 14 of the patients with residual/recurrent cholesteatoma, and the other 9 residual/recurrent lesions were eradicated using endoscope-assisted mastoidectomy. DWI overestimated cholesteatoma sites in 1 patient with residual lesion. The smallest cholesteatoma detected on DWI was a 3-mm lesion in the middle ear over the facial nerve.

CONCLUSION:

Primary and residual/recurrent cholesteatoma was accurately detected on non-EPI DWI with 98% clinical and radiologic concordance. Lesions less than 8 mm confined to the middle ear and its extensions can be eradicated with a minimally invasive endoscopic transcanal technique, whereas endoscope-assisted retroauricular mastoidectomy is preferred for larger lesions.

• Authors: Lela Migirov, Michael Wolf, Gahl Greenberg, Ana Eyal
• Journal: Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology (Otol Neurotol) Vol. 35 Issue 1 Pg. 121-5 (Jan 2014) ISSN: 1537-4505 [Electronic] United States
• PMID: 24317217 (Publication Type: Journal Article)

Topics

• Adolescent
• Adult
• Aged
• Child
• Child, Preschool
• Cholesteatoma, Middle Ear (pathology, surgery)
• Ear, Middle (pathology, surgery)
• Female
• Humans
• Magnetic Resonance Imaging (methods)
• Male
• Mastoid (pathology, surgery)
• Middle Aged
• Otologic Surgical Procedures (methods)
• Preoperative Care
• Preoperative Period
• Recurrence
• Treatment Outcome
• Young Adult