scholarly journals Transmastoid Repair of Temporal Meningoencephaloceles and Cerebrospinal Fluid Otorrhea

2011 ◽  
Vol 3 (1) ◽  
pp. 31-41 ◽  
Author(s):  
Werner Garavello ◽  
Lorenzo Gaini ◽  
Diego Zanetti
Keyword(s):  
Cerebrospinal Fluid ◽  
Temporal Bone ◽  
Process Management ◽  
Diagnostic Process ◽  
Mastoid Cavity ◽  
Tegmen Tympani ◽  
Surgical Options ◽  
Conductive Hearing ◽  
Transmastoid Approach ◽  
Csf Leaks

ABSTRACT This paper reviews the diagnosis and treatment of temporal bone meningoencephaloceles, defined as the herniation of meninges or brain tissue into empty spaces within the temporal bone, i.e. tympanic or mastoid cavity, through the tegmen tympani or antri respectively. It also describes the current methods of control of cerebrospinal fluid (CSF) leaks, which commonly present as serous otorrhea or rhinorrhea in addition to a variety of symptoms, such as conductive hearing loss. Imaging is the mainstay of the diagnostic process. Management of the condition is surgical, and this review outlines the surgical options with special emphasis on the transmastoid approach and the materials applicable for repair of the bony dehiscences.

scholarly journals Concomitant Dehiscences of the Temporal Bone: A Case-Based Study

2020 ◽  
pp. 014556132097378
Author(s):  
Maurizio Barbara ◽  
Valerio Margani ◽  
Anna Voltattorni ◽  
Simonetta Monini ◽  
Edoardo Covelli
Keyword(s):  
Hearing Loss ◽  
Inner Ear ◽  
Temporal Bone ◽  
Conductive Hearing Loss ◽  
Acoustic Energy ◽  
Superior Semicircular Canal Dehiscence ◽  
Local Bone ◽  
Tegmen Tympani ◽  
Vestibular Symptoms ◽  
Conductive Hearing

Otic capsule dehiscences create a pathological third window in the inner ear that results in a dissipation of the acoustic energy consequent to the lowered impedance. Superior semicircular canal dehiscence (SSCD) was identified by Minor et al in 1998 as a syndrome leading to vertigo and inner ear conductive hearing loss. The authors also reported the relation between the dehiscence and pressure- or sound-induced vertigo (Tullio’s phenomenon). Prevalence rates of SSCD in anatomical studies range from 0.4% to 0.7% with a majority of patients being asymptomatic. The observed association with other temporal bone dehiscences, as well as the propensity toward a bilateral or contralateral “near dehiscence,” raises the question of whether a specific local bone demineralization or systemic mechanisms could be considered. The present report regard a case of a patient with a previous episode of meningitis, with a concomitant bilateral SSCD and tegmen tympani dehiscence from the side of meningitis. The patient was affected by dizziness, left moderate conductive hearing loss, and pressure/sound-induced vertigo. Because of disabling vestibular symptoms, the patient underwent surgical treatment. A middle cranial fossa approach allowed to reach both dehiscences on the symptomatic side, where bone wax and fascia were used for repair. At 6 months from the procedure, hearing was preserved, and the vestibular symptoms disappeared.

scholarly journals Idiopathic temporal bone encephalocele: Diagnosed and treated during cochlear implantation

2020 ◽  
Vol 7 (12) ◽  
pp. 750-753
Author(s):  
Alexandros Poutoglidis ◽  
Pavlos Pavlidis ◽  
Georgios Katsilis ◽  
Gregory Alexander Schittek:
Keyword(s):  
Temporal Bone ◽  
Cochlear Implantation ◽  
Surgical Approaches ◽  
Diagnosis Delay ◽  
Common Complication ◽  
Case Presentation ◽  
Clinical Symptomatology ◽  
Tegmen Tympani ◽  
Fascia Lata Graft ◽  
Transmastoid Approach

Objective:    Meningoencephaloceles of the temporal bone are rare entities. There are two main categories, congenital and acquired. Acquired meningoencephaloceles are more common due to iatrogenic injury to the tegmen tympani which is a common complication during mastoidectomy. Case Presentation: We present a case of an idiopathic meningoencephalocele that was diagnosed and treated successfully during cochlear implantation via transmastoid approach. Fascia lata graft was used to reconstruct the deficit of tegmen tympani. Audiological outcome has been improved. Conclusions: Idiopathic Meningoencephaloceles present without specific clinical symptomatology and as a result diagnosis delay significant. In literature, there are various surgical approaches with mixed results.

Acrocephalosyndactyly (Apert's Syndrome): Temporal Bone Findings

1975 ◽  
Vol 84 (2) ◽  
pp. 174-178 ◽  
Author(s):  
John R. Lindsay ◽  
Franklin O. Black ◽  
William H. Donnelly
Keyword(s):  
Cerebrospinal Fluid ◽  
Hearing Impairment ◽  
Temporal Bone ◽  
Histologic Examination ◽  
Cochlear Aqueduct ◽  
Stapes Footplate ◽  
Apert's Syndrome ◽  
Conductive Hearing

The otologic manifestation of acrocephalosyndactyly (Apert's syndrome) has usually consisted of bilateral conductive hearing impairment. Invariably, fixation of the stapes footplate has been found at tympanotomy. Manipulation or removal of the stapes has resulted in a copious flow of fluid from the vestibule, suggesting an unusually patent cochlear aqueduct with escape of cerebrospinal fluid. Histologic examination of a temporal bone from an infant with acrocephalosyndactyly showed cartilaginous fixation of the stapes footplate. The lumen of the cochlear aqueduct was not unusually large or widely patent in this case.

scholarly journals Transmastoid Repair of Spontaneous Cerebrospinal Fluid Leaks

2018 ◽  
Vol 79 (05) ◽  
pp. 451-457 ◽  
Author(s):  
Enrique Perez ◽  
Daniel Carlton ◽  
Matthew Alfarano ◽  
Eric Smouha
Keyword(s):  
Cerebrospinal Fluid ◽  
Length Of Stay ◽  
Skull Base ◽  
Success Rate ◽  
Average Length ◽  
Tertiary Care ◽  
Success Rates ◽  
Base Thickness ◽  
Transmastoid Approach ◽  
Csf Leaks

Objective Determine the efficacy of using a purely transmastoid approach for the repair of spontaneous cerebrospinal fluid (CSF) leaks and further elucidate the relationship of elevated body mass index (BMI) and skull base thickness in our patient population. Method We conducted a retrospective chart review of patients treated for spontaneous temporal bone CSF leaks at our tertiary care institution from the years 2006 to 2015. Cases were categorized as primary or secondary. We analyzed success rates, length of stay, use of lumbar drains, BMIs, and rates of meningitis. Skull base thickness was compared with BMI in each case. Results We identified 26 primary operations for spontaneous CSF leaks and 7 secondary operations. Twenty-three of 33 repairs were performed via the transmastoid approach alone with an 87% success rate (20/23). Of the10 repairs including a middle cranial fossa (MCF) or combined MCF-transmastoid approach, 2 failed for an 80% success rate (8/10). Five transmastoid repairs underwent placement of a lumbar drain versus all 10 repairs employing an intracranial exposure. Average length of stay for those undergoing a transmastoid approach (1.7 days) was significantly shorter than for patients undergoing a MCF repair (6.3 days). Four patients presented with meningitis. Average BMI was 35.3. No correlation was established between BMI and skull base thickness (R 2 = 0.00011). Conclusion The transmastoid approach is effective in the majority of cases and prevents the need for an intracranial operation, resulting in lower morbidity and a shorter length of stay. We believe that this is the preferred primary approach in most patients with spontaneous CSF leaks.

Obliteration of the Middle Ear and Mastoid Cleft in Subtotal Petrosectomy: Indications, Technique, and Results

1986 ◽  
Vol 95 (1) ◽  
pp. 5-11 ◽  
Author(s):  
Newton J. Coker ◽  
Herman A. Jenkins ◽  
Ugo Fisch
Keyword(s):  
Temporal Bone ◽  
Middle Ear ◽  
External Auditory Canal ◽  
Complication Rate ◽  
Surgical Approaches ◽  
Mastoid Cavity ◽  
Subtotal Petrosectomy ◽  
Vascular Structures ◽  
Base Of The Skull ◽  
Conductive Hearing

Lateral surgical approaches to the base of the skull through the temporal bone often result in a large cavity with exposed dura and vascular structures and no possibility of reconstruction of the middle ear conductive hearing mechanism. Subtotal petrosectomy with tympanomastoid obliteration provides a relatively safe and secure closure of the surgical defect in the temporal bone and eliminates the problems associated with an open mastoid cavity. Eradication of all accessible air cell tracts and mucosa in the petrous pyramid, obliteration of the eustachian tubal orifice, closure of the external auditory canal, and fat obliteration of the middle ear and mastoid clefts are essential in the procedure. Over the last 10 years this technique has been utilized in 372 base of skull procedures with a complication rate of less than 5%. Infection occurred only in those cases with draining cavities or contaminated wounds.

Transmastoid approach to temporal bone cerebrospinal fluid leaks

2012 ◽  
Vol 33 (5) ◽  
pp. 556-561 ◽  
Author(s):  
Sepehr Oliaei ◽  
Hossein Mahboubi ◽  
Hamid R. Djalilian
Keyword(s):  
Cerebrospinal Fluid ◽  
Temporal Bone ◽  
Cerebrospinal Fluid Leaks ◽  
Transmastoid Approach

Cerebrospinal fluid otorrhoea following grommet insertion: management using a multi-layered graft technique and an important lesson revisited

2012 ◽  
Vol 127 (1) ◽  
pp. 70-72 ◽  
Author(s):  
S Patil ◽  
A Trinidade ◽  
M Yung ◽  
N Donnelly
Keyword(s):  
Cerebrospinal Fluid ◽  
Early Recognition ◽  
Cerebrospinal Fluid Leak ◽  
Important Lesson ◽  
Management Options ◽  
Grafting Technique ◽  
Tegmen Tympani ◽  
Uncommon Condition ◽  
Fluid Leak ◽  
Conductive Hearing

AbstractBackground:A spontaneous cerebrospinal fluid leak can sometimes only become apparent following grommet insertion and usually represents dehiscence of the tegmen tympani, which is an uncommon condition.Objectives:This report aimed to reaffirm the importance of recognising this unusual presentation and outline management options.Case report:A 63-year-old man with conductive hearing loss and type B (flat) tympanometry underwent grommet insertion into his left ear, which resulted in cerebrospinal fluid otorrhoea. A defect of the tegmen tympani was found. This was successfully repaired via a transmastoid approach using a multi-layered grafting technique.Conclusion:Dehiscence of the tegmen tympani is uncommon and may only come to light following grommet insertion, which may be problematic for the uninformed otolaryngologist. Education is important to ensure early recognition and appropriate management.

Transmastoid Approach to Spontaneous Temporal Bone CSF Leaks: Hearing Improvement and Success of Repair

2013 ◽  
Vol 149 (2_suppl) ◽  
pp. P111-P112
Author(s):  
Leslie Kim ◽  
Clayton E. Wisely ◽  
Edward E. Dodson
Keyword(s):  
Temporal Bone ◽  
Hearing Improvement ◽  
Transmastoid Approach ◽  
Csf Leaks

Surgical management of temporal meningoencephaloceles, cerebrospinal fluid leaks, and intracranial hypertension: treatment paradigm and outcomes

2012 ◽  
Vol 32 (6) ◽  
pp. E6 ◽  
Author(s):  
Tyler J. Kenning ◽  
Thomas O. Willcox ◽  
Gregory J. Artz ◽  
Paul Schiffmacher ◽  
Christopher J. Farrell ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Temporal Bone ◽  
Cranial Base ◽  
Csf Leak ◽  
Preoperative Imaging ◽  
Ventriculoperitoneal Shunting ◽  
Anterior Cranial Base ◽  
Tegmen Tympani ◽  
Treatment Paradigm ◽  
Csf Leaks

Object Thinning of the tegmen tympani and mastoideum components of the temporal bone may predispose to the development of meningoencephaloceles and spontaneous CSF leaks. Surgical repair of these bony defects and associated meningoencephaloceles aids in the prevention of progression and meningitis. Intracranial hypertension may be a contributing factor to this disorder and must be fully evaluated and treated when present. The purpose of this study was to establish a treatment paradigm for tegmen defects and elucidate causative factors. Methods The authors conducted a retrospective review of 23 patients undergoing a combined mastoidectomy and middle cranial fossa craniotomy for the treatment of a tegmen defect. Results The average body mass index (BMI) among all patients was 33.2 ± 7.2 kg/m2. Sixty-five percent of the patients (15 of 23) were obese (BMI > 30 kg/m2). Preoperative intracranial pressures (ICPs) averaged 21.8 ± 6.0 cm H2O, with 10 patients (43%) demonstrating an ICP > 20 cm H2O. Twenty-two patients (96%) had associated encephaloceles. Five patients underwent postoperative ventriculoperitoneal shunting. Twenty-two CSF leaks (96%) were successfully repaired at the first attempt (average follow-up 10.4 months). Conclusions Among all etiologies for CSF leaks, those occurring spontaneously have the highest rate of recurrence. The surgical treatment of temporal bone defects, as well as the recognition and treatment of accompanying intracranial hypertension, provides the greatest success rate in preventing recurrence. After tegmen dehiscence repair, ventriculoperitoneal shunting should be considered for patients with any combination of the following high-risk factors for recurrence: spontaneous CSF leak not caused by another predisposing condition (that is, trauma, chronic infections, or prior surgery), high-volume leaks, CSF opening pressure > 20 cm H2O, BMI > 30 kg/m2, preoperative imaging demonstrating additional cranial base cortical defects (that is, contralateral tegmen or anterior cranial base) and/or an empty sella turcica, and any history of an event that leads to inflammation of the arachnoid granulations and impairment of CSF absorption (that is, meningitis, intracranial hemorrhage, significant closed head injury, and so forth).

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