Kirurško razmatranje u liječenju kolesterolskog granuloma petroznog apeksa kroz infrakohlearni pristup

master's thesis

• Title (english): Surgical considerations in addressing cholesterol granuloma of the petrous apex through an infracochlear approach
• Author: Josip Prnjak
• Mentor: Andro Košec (mentor)
• Committee member: Jakov Ajduk (predsjednik povjerenstva)
• Committee member: Mihael Ries (član povjerenstva)
• Committee member: Andro Košec (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Othorhinolaryngology and Head and Neck Surgery); Zagreb
• Defense date and country: 2023-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Otorhinolaryngology

Abstract

Kolesterolski granulom je lezija koja nastaje kao posljedica imunološke reakcije na kolesterolske kristale nastale anaerobnom razgradnjom krvnih produkata. Iako je incidencija izrazito niska, ipak se smatra najčešćom patologijom u području petroznog apeksa temoporalne kosti. Rast ove lezije je spor i asimptomatski sve dok ne dođe do kompresije okolnih struktura poput unutarnjeg uha i kranijalnih živaca. Dijagnostika zahtjeva detaljnu audiološku i radiološku obradu s preciznim određivanjem lokalizacije lezije te odnosa s okolnim neurovaskularnim strukturama. Često se otkrije kao usputni nalaz te kirurško liječenje u takvim slučajevima nije potrebno, već se provodi aktivni nadzor prateći veličinu lezije i kliničku sliku. Kod simptomatskih slučajeva indicirano je kirurško liječenje u kojem prednost imaju drenažni postupci kod kojih se stijenka lezije ne uklanja. Razlog tome je to što je kolesterolski granulom pseudocista koja nema pravu epitelnu ovojnicu. Odluka o kirurškom pristupu ovisi o sluhu na zahvaćenoj strani, lokalizaciji lezije, anatomskim okolnostima i iskustvu kirurga. U slučaju očuvanog sluha, postoji nekoliko kirurških pristupa kojima se čuva labirint među kojima je i infrakohlearni pristup. Ova kirurška tehnika omogućuje minimalno invazivan pristup na petrozni apeks i dugoročnu drenažu sadržaja u srednje uho. Zbog obilja neurovaskularnih struktura koje ograničavaju infrakohlearni anatomski odjeljak, pažljiva priprema i poznavanje anatomije su presudni u sprječavanju komplikacija.

Abstract (english)

Cholesterol granuloma is a lesion that develops as a result of an immune reaction to cholesterol crystals formed by the anaerobic breakdown of blood products. Although the incidence is extremely low, it is considered the most common pathology in the petrous apex area. The growth of this lesion is slow and asymptomatic until it compresses surrounding structures such as the inner ear and cranial nerves. Diagnosis requires detailed audiological and radiological evaluation with precise determination of the lesion's location and its relationship with adjacent neurovascular structures. It is often discovered incidentally, and in such cases, surgical treatment is not necessary but active surveillance is conducted, monitoring the size of the lesion and clinical presentation. In symptomatic cases, surgical treatment is indicated, with preference given to drainage procedures that do not require the removal of the lesion's wall. This is because a cholesterol granuloma is a pseudocyst that lacks a true epithelial lining. The decision regarding the surgical approach depends on the hearing status on the affected side, the localization of the lesion, the anatomical position of critical structures, and the surgeon's experience. In cases where hearing function is preserved, several surgical approaches can be used to spare the labyrinth, including the infracochlear approach. This surgical technique allows for a minimally invasive approach to the petrous apex and long-term drainage of the contents into the middle ear. Due to the abundance of neurovascular structures that limit the infracochlear compartment, attention and skill are essential in preventing complications.

• Keywords: kolesterolski granulom; infrakohlearni pristup; neurotologija
• Keywords (english): cholesterol granuloma; infracochlear approach; neurotology
• Language: croatian
• URN:NBN: urn:nbn:hr:105:016531
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-10-30 11:04:44