scholarly journals Extensive Pneumocephalus Secondary to Petrous Bone Cholesteatoma

2021 ◽  
pp. 014556132110489
Author(s):  
Sultan Alanazy ◽  
Sung Il Cho
Keyword(s):  
Internal Auditory Canal ◽  
Semicircular Canals ◽  
Cerebrospinal Fluid Leak ◽  
Petrous Bone ◽  
Bony Destruction ◽  
Fluid Leak ◽  
Radiological Studies ◽  
Sudden Headache ◽  
Transotic Approach ◽  
Petrous Bone Cholesteatoma

Pneumocephalus refers to air inside the cranium; however, otogenic pneumocephalus is rarely reported in the literature. The neurological presentations of pneumocephalus include headache, lethargy, confusion, disorientation, and seizure. Here, we have reported a case of a 42-year-old woman with extensive pneumocephalus and cerebrospinal fluid leak secondary to petrous bone cholesteatoma. She presented to the emergency department with sudden headache and left ear discharge. Physical examination revealed watery otorrhea through a hole in the tympanic membrane. Radiological studies demonstrated extensive soft tissue in the left middle ear and mastoid extending to the internal auditory canal. Free intracranial air was observed, and bony destruction was seen in the cochlea, vestibule, and semicircular canals. The patient was managed surgically via the transotic approach and fully recovered. Although otogenic pneumocephalus is rarely encountered in clinical practice, early diagnosis and urgent management are important to prevent fatal complications.

Surgical Strategy and Facial Nerve Outcomes in Petrous Bone Cholesteatoma

2016 ◽  
Vol 21 (5) ◽  
pp. 275-285 ◽  
Author(s):  
Sampath Chandra Prasad ◽  
Gianluca Piras ◽  
Enrico Piccirillo ◽  
Abdelkader Taibah ◽  
Alessandra Russo ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Petrous Bone ◽  
Common Type ◽  
Active Management ◽  
Nerve Grafting ◽  
The Mean ◽  
Transotic Approach ◽  
Petrous Bone Cholesteatoma

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. Methods: This was a retrospective study. The setting was a quaternary referral center for skull base pathology in Italy. A total of 200 patients with 201 PBCs were included in the study. All patients diagnosed radiologically with PBCs were classified according to the Sanna classification. All patients were surgically treated and followed up with radiology. The main outcome measures - classification of PBCs, the surgical approach used, disease control, and FN outcomes - were analyzed. Results: Supralabyrinthine PBCs were the most common type with 92 cases (45.8%) followed by the massive PBCs with 72 cases (35.8%). Preservation of preoperative FN function was highest in the infralabyrinthine (72.2%) and infralabyrinthine-apical (73.3%) types. The transotic approach was used in 66 cases (32.8%) in this series. The modified transcochlear approach type A was applied in 55 cases (27.3%). Active management of the nerve (rerouting, anastomosis, or grafting) was required in 53 cases (26.4%). Postoperatively, of the 116 cases with FN House-Brackmann grade I and II, 107 cases (92.2%) retained the same grade or improved. Recurrence was seen in 7 cases (3.5%). The mean duration of follow-up was 6.3 years. Conclusions: Radical disease clearance must take precedence over hearing and FN preservation in PBCs. Active FN management, including rerouting, end-to-end anastomosis, and cable nerve grafting, routinely come to play in the surgical management of PBCs, and the postoperative FN results after such interventions can be satisfactory in most cases.

scholarly journals Spontaneous Cerebrospinal Fluid Leak through the Posterior Aspect of the Petrous Bone

Skull Base ◽  
2011 ◽  
Vol 21 (S 02) ◽  
pp. e10-e10
Author(s):  
Garani Nadaraja ◽  
Ashkan Monfared ◽  
Robert Jackler
Keyword(s):  
Cerebrospinal Fluid ◽  
Cerebrospinal Fluid Leak ◽  
Petrous Bone ◽  
Posterior Aspect ◽  
Fluid Leak

scholarly journals Acoustic neuroma (vestibular schwannoma): surgical results on 240 patients operated on dorsal decubitus position

2007 ◽  
Vol 65 (3a) ◽  
pp. 605-609 ◽  
Author(s):  
Arquimedes Cavalcante Cardoso ◽  
Yvens B. Fernandes ◽  
Ricardo Ramina ◽  
Guilherme Borges
Keyword(s):  
Vestibular Schwannoma ◽  
Tumor Resection ◽  
Cranial Nerves ◽  
Internal Auditory Canal ◽  
Air Embolism ◽  
Cerebrospinal Fluid Leak ◽  
Surgical Removal ◽  
Venous Air Embolism ◽  
Craniotomy For Tumor Resection ◽  
Fluid Leak

OBJECTIVE: To evaluate the result of the surgical treatment of vestibular schwannoma (VS) operated in dorsal decubitus (mastoid position). METHOD: 240 patients with a VS underwent a retrosigmoid craniotomy for tumor resection in dorsal decubitus (mastoid position). The function of 7th and 8th cranial nerves was monitored during surgery and the opened internal auditory canal (IAC) was reconstructed using a vascularized dura flap, muscle and fibrin glue. RESULTS: Complete tumor removal was achieved in 99% of the cases, with a mortality of 1.6%. The facial nerve function was preserved in 85% of cases and hearing in 40% of the patients (with preoperative hearing) with tumors of up 1.5 cm in diameter. The incidence of cerebrospinal fluid leak was 5.8% and meningitis 2.9%. Venous air embolism was registered in 3% of cases; it was not associated to mortality. CONCLUSION: Surgical removal of VS in dorsal position has several advantages; the morbidity and mortality are very low.

scholarly journals Spontaneous Cerebrospinal Fluid Leak through the Posterior Aspect of the Petrous Bone

2011 ◽  
Vol 145 (2_suppl) ◽  
pp. P227-P227
Author(s):  
Garani S. Nadaraja ◽  
Ashkan Monfared ◽  
Robert K. Jackler
Keyword(s):  
Cerebrospinal Fluid ◽  
Cerebrospinal Fluid Leak ◽  
Petrous Bone ◽  
Posterior Aspect ◽  
Fluid Leak

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.

scholarly journals Infralabyrinthine petrous bone cholesteatoma (literature review)

2020 ◽  
pp. 140-149
Author(s):  
K. M. Diab ◽  
O. S. Panina ◽  
O. A. Pashchinina
Keyword(s):  
Literature Review ◽  
Recurrence Rate ◽  
Clinical Symptoms ◽  
Petrous Bone ◽  
Lateral Skull Base ◽  
Number Of Patients ◽  
Subtotal Petrosectomy ◽  
Comparison Of The Results ◽  
Transotic Approach ◽  
Petrous Bone Cholesteatoma

A literature review on the infralabyrinthine petrous bone cholesteatoma (PBC) was presented in this article. Attention is paid to etiology and clinical symptoms of the disease, classifications. All modern classifications divide cholesteatoma with localization under the labyrinth into two big groups: infralabyrinthine and infralabyrinthine apical. This is not enough to determine the algorithm of surgical tactic of these patients. The most used approaches to the infrlabyrinyhine area and lateral skull base were analyzed (infralabyrinthine and infracochlear, subtotal petrosectomy, transotic approach, group of transcochlear approaches, infratemporal and translabyrinthine approaches). Possible variants of the surgery ending are described (tympanoplasty or “cul-de-sac” closure). Comparison of the results of different authors, starting from 1990, in which the infralabyrinthine cholesteatoma was distinguished as a separate class was carried out. 16 publications were analyzed based on the type of used classification, the total number of cases with infralabyrinthine cholesteatoma, the type of surgical approach, the complications and recurrence rate. The total number of patients was 141, 84 with infralabyrinthine (59,6%), 57 (40,4%) with infralabyrinthine apical PBC. The most common type of surgery were subtotal petrosectomy, transcochlear approach in different variations and transotic approach. The recurrence rate ranged from 0 to 29%. This paper identifies unresolved issues, the necessity of new classification and algorithm of surgical management based on it.

Bilateral cochlear implantation in a patient with petrous bone cholesteatoma in the only hearing ear: case report

2011 ◽  
Vol 125 (12) ◽  
pp. 1272-1274 ◽  
Author(s):  
S T Husseini ◽  
M Guida ◽  
M Negri ◽  
M Falcioni
Keyword(s):  
Case Report ◽  
Cochlear Implantation ◽  
English Language ◽  
Internal Auditory Canal ◽  
Petrous Bone ◽  
Successful Outcome ◽  
Sentence Recognition ◽  
Open Set ◽  
History Of ◽  
Petrous Bone Cholesteatoma

AbstractObjective:We report a case of successful cochlear implantation in a patient with petrous bone cholesteatoma in the only hearing ear.Case report:A 63-year-old man presented with a four-year history of right-sided, progressive hearing loss in his only hearing ear. Computed tomography and magnetic resonance imaging revealed a right supralabyrinthine petrous bone cholesteatoma, with erosion of the superior semicircular canal and the roof of the internal auditory canal. Due to the high risk of post-operative right-sided deafness, we decided first to perform left cochlear implantation. Five months later, the patient had a 40 per cent score for open-set two-syllable word recognition and an 85 per cent score for sentence recognition. Given these good performances, we decided to eradicate the cholesteatoma via a translabyrinthine approach, with insertion of a second cochlear implant, as a single-stage procedure. A successful outcome was achieved.Conclusion:Cochlear implantation can be an effective method of hearing rehabilitation in patients with petrous bone cholesteatoma, following total eradication of disease, if the cochlea remains intact. To our best knowledge, this is the first English language report of cochlear implantation in a patient with petrous bone cholesteatoma.

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