Colesteatoma gigante en fosa posterior. Informe de caso

Abstract

Introduction: congenital cholesteatomas are benign lesions of the middle ear, with slow and progressive growth; They can reach a large size before causing symptoms, which reveal their presence only in advanced stages. Surgical intervention is the treatment modality in all cases. There are no reports of similar cases in Cuba.

Objective: to present a case of a patient with the clinical, imaging and pathological characteristics of a congenital cholesteatoma of the posterior fossa.

Case presentation: 48-year-old male patient, who started with tinnitus and left hearing loss and loss of balance. The neurological examination revealed dysmetria, dyschronometry and horizontal nystagmus. Imaging studies reported an occupying lesion in the cerebellopontine angle without bone erosion. The patient refused surgery for three years and developed new symptoms due to trigeminal paresthesias, headache and dysphonia, as well as left peripheral facial paralysis. A suboccipital retrosigmoid approach was carried out, a pearly white lesion related to a cholesteatoma was found, confirmed by biopsy. Subtotal resection was achieved. He presented post-surgical chemical meningitis which resolved spontaneously. The evolution was satisfactory.

Conclusions: intracranial congenital cholesteatomas are very rare lesions and are sometimes similar to other lesions in the posterior cranial fossa. Imaging, they appear as well-defined lesions that do not present enhancement after contrast administration. In this patient, the evolution was favorable, despite the late surgical treatment, due to its initial refusal.