Diagnosis, classification and surgical management of Petrous Bone Cholesteatomas: Gruppo Otologico experience of 200 consecutive patients. Objective: To review the classification and management of Petrous Bone Cholesteatomas (PBCs) at our center and the outcomes of facial nerve (FN) management in these lesions. Study Design: Retrospective study. Setting: A quarternary referral center in Italy for Skull Base pathology. Patients: 200 patients with 201 PBCs were included in the study.

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... : All patients diagnosed radiologically to have PBCs were classified according to the Sanna Classification. All patients were surgically treated and followed up with radiology. Main Outcome Measures: Classification of PBCs, surgical approach used, disease control and FN outcomes were analysed. Results: Supralabyrinthine PBCs were the most common type with 92 (45.8%) cases followed by the Massive PBCs with 72 (35.8%) cases. Preservation of pre-operative facial nerve function was highest in the Infralabyrinthine (72.2%) and Infralabyrinthine-apical (73.3%) types. The Transotic Approach was used in 66 (32.8%) cases in this series. The MTCA -Type A was applied in 55 (27.3%) of the cases. An active management of the nerve (re-routing, anastomosis or grafting) was required in 53 (26.4%) cases. Post-operatively, of the 116 cases with FN HB Grade I and II, 107 (92.2%) cases retained the same grade or improved. Recurrence was seen in seven (3.5%) cases. Learning Objectives: Demonstrate that homologous bone graft from a bone bank can be a nonexpensive and easy-touse filler material for mastoid obliteration.