scholarly journals Cerebrospinal Fluid Leak During Stapes Surgery: The Importance of Temporal Bone CT Reconstructions in Oblique Anatomically Oriented Planes

2021 ◽  
pp. 014556132098456
Author(s):  
Massimo Re ◽  
Mirko Giannoni ◽  
Alfonso Scarpa ◽  
Claudia Cassandro ◽  
Massimo Ralli ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Temporal Bone ◽  
Internal Auditory Canal ◽  
Cerebrospinal Fluid Leak ◽  
High Resolution Computed Tomography ◽  
Temporal Bone Ct ◽  
Patients At Risk ◽  
Bone Structures ◽  
Fluid Leak

Stapes gusher is a massive flow of perilymph and cerebrospinal fluid leak that fills the middle ear immediately after surgical opening of the labyrinth, such as during stapedectomy. Stapes gusher usually occurs as the result of a congenital malformation that causes an abnormal communication between the perilymphatic space and the subarachnoid space involving the internal auditory canal or the cochlear duct. To date, the potential risk of stapes gusher cannot be assessed preoperatively, as there are not pathognomonic signs suggestive of this complication. However, high-resolution computed tomography scan (HRCT) of the temporal bone can provide information that may help recognizing patients at risk. Recently, an anatomic evaluation of the inner ear with oblique reformation at HRCT has been described. This reformation offers a new and more detailed topographic vision of temporal bone structures compared to the classic axial and coronal planes and may help identifying anatomical alterations otherwise not visible. In this article, we present a case of stapes gusher and the role of preoperative HRCT with oblique reformation in its prevention.

The role of ICP monitoring in patients with persistent cerebrospinal fluid leak following spinal surgery: a case series

2016 ◽  
Vol 158 (9) ◽  
pp. 1813-1819 ◽  
Author(s):  
Claudia Craven ◽  
Ahmed K. Toma ◽  
Akbar A. Khan ◽  
Laurence D. Watkins
Keyword(s):  
Cerebrospinal Fluid ◽  
Spinal Surgery ◽  
Case Series ◽  
Cerebrospinal Fluid Leak ◽  
Icp Monitoring ◽  
Fluid Leak

scholarly journals Erratum to “Surgical outcomes in the treatment of temporal bone cerebrospinal fluid leak: A systematic review” [Auris Nasus Larynx 45 (2018) 903–910]

2019 ◽  
Vol 46 (3) ◽  
pp. 483
Author(s):  
Federico Maria Gioacchini ◽  
Ettore Cassandro ◽  
Matteo Alicandri-Ciufelli ◽  
Shaniko Kaleci ◽  
Claudia Cassandro ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cerebrospinal Fluid ◽  
Temporal Bone ◽  
Surgical Outcomes ◽  
Cerebrospinal Fluid Leak ◽  
Fluid Leak

Management of temporal bone meningo-encephalocoele

2008 ◽  
Vol 122 (11) ◽  
pp. 1168-1174 ◽  
Author(s):  
K K Ramalingam ◽  
R Ramalingam ◽  
T M SreenivasaMurthy ◽  
G R Chandrakala
Keyword(s):  
Cerebrospinal Fluid ◽  
Temporal Bone ◽  
Otitis Media ◽  
Cerebrospinal Fluid Leak ◽  
Ossicular Chain ◽  
Brain Herniation ◽  
Suppurative Otitis Media ◽  
Ossicular Chain Reconstruction ◽  
Fluid Leak ◽  
Mastoid Surgery

AbstractMeningo-encephalocoele of the temporal bone, also known as fungus cerebri, is a rare occurrence in clinical practice. We present a series of 13 patients with chronic otitis media who suffered brain herniation into the mastoid cavity. We also discuss the presentation and management of brain herniation with or without cerebrospinal fluid leak.Study design:Retrospective.Methods:Among 963 cases undergoing revision mastoid surgery, 13 patients suffered brain herniation. These cases were identified and analysed.Results:All 13 patients' initial diagnosis was chronic suppurative otitis media with cholesteatoma, and all had undergone previous mastoid surgery resulting in a defect in the tegmen and weakening of the dura mater. The revision procedures performed included 10 (76.9 per cent) modified radical mastoidectomies without ossicular chain reconstruction and one (7.6 per cent) modified radical mastoidectomy with ossicular chain reconstruction; two (15.3 per cent) patients required a blind sac closure. Brain herniation and/or cerebrospinal fluid leak were repaired by a transmastoid ± minicraniotomy procedure.Conclusions:Injury to the tegmen and dura should be avoided during surgery for chronic middle-ear disease. Cerebrospinal fluid leaks, if encountered, should be managed in the same surgical session. The transmastoid approach is helpful in repairing defects smaller than 1 cm in diameter, whereas the combined transmastoid-minicraniotomy approach provides good access when closing defects larger than 1 cm in diameter and also enables auto-calvarial grafting.

Temporal Bone Encephalocele and Cerebrospinal Fluid Leak Repair via the Middle Cranial Fossa Approach

2013 ◽  
Vol 74 (S 01) ◽  
Author(s):  
Matthew Carlson ◽  
William Copeland ◽  
Stanley Pelosi ◽  
Colin Driscoll ◽  
Michael Link ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Temporal Bone ◽  
Cerebrospinal Fluid Leak ◽  
Middle Cranial Fossa ◽  
Middle Cranial Fossa Approach ◽  
Cranial Fossa ◽  
Fluid Leak

Cerebrospinal Fluid Leak of Temporal Bone Origin

1995 ◽  
Vol 112 (5) ◽  
pp. P39-P39
Author(s):  
Ronald A. Hoffman
Keyword(s):  
Cerebrospinal Fluid ◽  
Temporal Bone ◽  
Cerebrospinal Fluid Leak ◽  
Educational Objectives ◽  
Fluid Leak

Educational objectives: To diagnose cerebrospinal fluid leak and to be knowledgeable regarding therapy.

Radiological findings in spontaneous cerebrospinal fluid leaks of the temporal bone

2021 ◽  
pp. 1-7
Author(s):  
T Hendriks ◽  
A Thompson ◽  
R Boeddinghaus ◽  
H E I Tan ◽  
J Kuthubutheen
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Cerebrospinal Fluid ◽  
Magnetic Resonance ◽  
Temporal Bone ◽  
Cerebrospinal Fluid Leak ◽  
Resonance Imaging ◽  
Cerebrospinal Fluid Leaks ◽  
Temporal Bones ◽  
Fluid Leak

Abstract Background and objective Spontaneous cerebrospinal fluid leak of the temporal bone is an emerging clinical entity for which prompt and accurate diagnosis is difficult given the subtle signs and symptoms that patients present with. This study sought to describe the key temporal bone abnormalities in patients with spontaneous cerebrospinal fluid leak. Methods A retrospective cohort study was conducted of adult patients with biochemically confirmed spontaneous cerebrospinal fluid leak. Demographics and radiological features identified on computed tomography imaging of the temporal bones and/or magnetic resonance imaging were analysed. Results Sixty-one patients with spontaneous cerebrospinal fluid leak were identified. Fifty-four patients (88.5 per cent) underwent both temporal bone computed tomography and magnetic resonance imaging. Despite imaging revealing bilateral defects in over 75 per cent of the cohort, only two patients presented with bilateral spontaneous cerebrospinal fluid leaks. Anterior tegmen mastoideum defects were most common, with an average size of 2.5 mm (range, 1–10 mm). Conclusion Temporal bone computed tomography is sensitive for the identification of defects when suspicion exists. In the setting of an opacified middle ear and/or mastoid, close examination of the skull base is crucial given that this fluid is potentially cerebrospinal fluid.

scholarly journals Risk of Posterior Semicircular Canal Trauma when using a Retrosigmoid approach for Acoustic Neuroma Surgery and role of Endoscopy: An Imaging Study

2018 ◽  
Vol 97 (1-2) ◽  
pp. 24-30 ◽  
Author(s):  
Ali Kouhi ◽  
Varasteh Vakili Zarch ◽  
Ali Pouyan
Keyword(s):  
Temporal Bone ◽  
Semicircular Canal ◽  
Internal Auditory Canal ◽  
Imaging Study ◽  
Hearing Preservation ◽  
Neoplastic Disease ◽  
Posterior Semicircular Canal ◽  
Temporal Bone Ct ◽  
Temporal Bones

The rate of hearing preservation after vestibular schwannoma surgery is variable and is not as high as expected, possibly due to injuries to the posterior semicircular canal while exposing the tumor. The aim of this study was to estimate the risk of posterior semicircular canal injuries using temporal bone computed tomography (CT) scan findings. Temporal bone CT scans of 30 patients selected between 2013 and 2015 were studied. The median age of the patients was 40 years. Two planes were studied: (1) the axial plane that shows the common crus of the posterior semicircular canal and (2) the coronal plane that shows the two crura of the posterior semicircular canal. Five lines were drawn and four angles and three distances were measured. In this study, we divided the patients into three groups consisting of 10 patients each: (1) patients with no evidence of inflammatory or neoplastic disease, (2) those with chronic ear disease, and (3) those with vestibular schwannomas. The portion of the internal auditory canal that was exposed by drilling while preserving the posterior semicircular canal was 53 to 64% and 61 ± 9% in whole temporal bones in the three groups. The mean angle of vision with an endoscope was less than 105° in 56% of cases, which means even with a 30° endoscope, the fundus could not be visualized. Therefore, according to our data, it seemed impossible to expose the whole length of the internal auditory canal from the porus to the fundus without causing injury to the posterior semicircular canal. However, the use of endoscopes may help to prevent injury.

scholarly journals Risk of Posterior Semicircular Canal Trauma When Using a Retrosigmoid Approach for Acoustic Neuroma Surgery and Role of Endoscopy: An Imaging Study

2018 ◽  
Vol 97 (1-2) ◽  
pp. 24-30
Author(s):  
Ali Kouhi ◽  
Varasteh Vakili Zarch ◽  
Ali Pouyan
Keyword(s):  
Temporal Bone ◽  
Semicircular Canal ◽  
Internal Auditory Canal ◽  
Imaging Study ◽  
Hearing Preservation ◽  
Neoplastic Disease ◽  
Posterior Semicircular Canal ◽  
Temporal Bone Ct ◽  
Temporal Bones

The rate of hearing preservation after vestibular schwannoma surgery is variable and is not as high as expected, possibly due to injuries to the posterior semicircular canal while exposing the tumor. The aim of this study was to estimate the risk of posterior semicircular canal injuries using temporal bone computed tomography (CT) scan findings. Temporal bone CT scans of 30 patients selected between 2013 and 2015 were studied. The median age of the patients was 40 years. Two planes were studied: (1) the axial plane that shows the common crus of the posterior semicircular canal and (2) the coronal plane that shows the two crura of the posterior semicircular canal. Five lines were drawn and four angles and three distances were measured. In this study, we divided the patients into three groups consisting of 10 patients each: (1) patients with no evidence of inflammatory or neoplastic disease, (2) those with chronic ear disease, and (3) those with vestibular schwannomas. The portion of the internal auditory canal that was exposed by drilling while preserving the posterior semicircular canal was 53 to 64% and 61 ± 9% in whole temporal bones in the three groups. The mean angle of vision with an endoscope was less than 105° in 56% of cases, which means even with a 30° endoscope, the fundus could not be visualized. Therefore, according to our data, it seemed impossible to expose the whole length of the internal auditory canal from the porus to the fundus without causing injury to the posterior semicircular canal. However, the use of endoscopes may help to prevent injury.

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