Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-28T20:10:23.841Z Has data issue: false hasContentIssue false
  • English
  • Français

Temporal bone meningoencephaloceles and cerebrospinal fluid leaks: experience in a tertiary care hospital

Published online by Cambridge University Press:  19 February 2019

A Gupta ,
K Sikka ,
D V K Irugu ,
H Verma ,
A S Bhalla  and
A Thakar
A Gupta
Affiliation:
Department of Otolaryngology and Head–Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
K Sikka
Affiliation:
Department of Otolaryngology and Head–Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
D V K Irugu
Affiliation:
Department of Otolaryngology and Head–Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
H Verma
Affiliation:
Department of Otolaryngology and Head–Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
A S Bhalla
Affiliation:
Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
A Thakar*
Affiliation:
Department of Otolaryngology and Head–Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
*
Author for correspondence: Dr Alok Thakar, Department of Otolaryngology and Head–Neck Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India E-mail: [email protected] Fax: +91 (0)1126593492
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

To recount experience with cerebrospinal fluid otorrhoea and temporal bone meningoencephalocele repair in a tertiary care hospital.

Method

A retrospective review was conducted of 16 cerebrospinal fluid otorrhoea and meningoencephalic herniation patients managed surgically from 1991 to 2016.

Results

Aetiology was: congenital (n = 3), post-traumatic (n = 2), spontaneous (n = 1) or post-mastoidectomy (n = 10). Surgical repair was undertaken by combined middle cranial fossa and transmastoid approach in 3 patients, transmastoid approach in 2, oval window plugging in 1, and subtotal petrosectomy with middle-ear obliteration in 10. All patients had successful long-term outcomes, except one, who experienced recurrence after primary stage oval window plugging, but has been recurrence-free after second-stage subtotal petrosectomy with middle-ear obliteration.

Conclusion

Dural injury or exposure in mastoidectomy may lead to cerebrospinal fluid otorrhoea or meningoencephalic herniation years later. Congenital, spontaneous and traumatic temporal bone defects may present similarly. Middle cranial fossa dural repair, transmastoid multilayer closure and subtotal petrosectomy with middle-ear obliteration were successful procedures. Subtotal petrosectomy with middle-ear obliteration offers advantages over middle cranial fossa dural repair alone; soft tissue closure is more robust and is preferred in situations where hearing preservation is not a priority.

Keywords

Temporal BoneEncephaloceleCerebrospinal Fluid OtorrheaCerebrospinal Fluid RhinorrheaMeningitisCranial Fossa, MiddleOtitis MediaCholesteatoma, Middle EarMastoidEar, Middle
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 133 , Issue 3 , March 2019 , pp. 192 - 200
Copyright
Copyright © JLO (1984) Limited, 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Dr A Thakar takes responsibility for the integrity of the content of the paper

Presented as a paper at the Indian Society of Otology conference, 20 November 2017, Raipur, India.

References

1Sanna, M, Fois, P, Russo, A, Falcioni, M. Management of meningoencephalic herniation of the temporal bone: personal experience and literature review. Laryngoscope 2009;119:1579–85Google Scholar
2Wootten, CT, Kaylie, DM, Warren, FM, Jackson, CG. Management of brain herniation and cerebrospinal fluid leak in revision chronic ear surgery. Laryngoscope 2005;115:1256–61Google Scholar
3Feenstra, L, Sanna, M, Zini, C, Gamoletti, R, Delogu, P. Surgical treatment of brain herniation into the middle ear and mastoid. Am J Otol 1985;6:311–15Google Scholar
4Glasscock, MD Jr, Jackson, GC, Wiet, JR. Surgical management of brain tissue into the middle ear and mastoid. Laryngoscope 1979;89:1743–54Google Scholar
5Iurato, S, Ettore, GC, Selvini, C. Brain herniation into the middle ear: two idiopathic cases treated by a combined intracranial mastoid approach. Laryngoscope 1989;99:950–4Google Scholar
6Jackson, DG, Pappas, DG Jr, Manolidis, S, Glasscock, ME 3rd, Von Doersten, PG, Hampf, CR et al. Brain herniation into the middle ear and mastoid: concepts in diagnosis and surgical management. Am J Otol 1997;18:198–205Google Scholar
7Neely, JG, Kuhn, JR. Diagnosis and treatment of iatrogenic cerebrospinal fluid leak and brain herniation during or following mastoidectomy. Laryngoscope 1985;95:1299–300Google Scholar
8Savva, A, Taylor, MJ, Beatty, CW. Management of cerebrospinal fluid leaks involving the temporal bone: report on 92 patients. Laryngoscope 2003;113:50–6Google Scholar
9Ferguson, BJ, Wilkins, RH, Hudson, W, Farmer, J Jr. Spontaneous CSF otorrhea from tegmen and posterior fossa defects. Laryngoscope 1986;96:635–44Google Scholar
10Lundy, LB, Graham, MD, Kartush, JM, La Rouere, MJ. Temporal bone encephalocele and cerebrospinal fluid leaks. Am J Otol 1996;17:461–9Google Scholar
11Wetmore, SJ, Herrmann, P, Fisch, U. Spontaneous cerebrospinal fluid otorrhea. Am J Otol 1987;8:96–102Google Scholar
12Kamerer, DB, Caparosa, RJ. Temporal bone encephalocele--diagnosis and treatment. Laryngoscope 1982;92:878–82Google Scholar
13Mosnier, I, Fiky, LEL, Shahidi, A, Sterkers, O. Brain herniation and chronic otitis media: diagnosis and surgical management. Clin Otolaryngol Allied Sci 2000;25:385–91Google Scholar
14Rao, AK, Merenda, DM, Wetmore, SJ. Diagnosis and management of spontaneous cerebrospinal fluid otorrhea. Otol Neurotol 2005;26:1171–5Google Scholar
15Mayeno, JK, Korol, HW, Nutik, SL. Spontaneous meningoencephalic herniation of the temporal bone: case series with recommended treatment. Otolaryngol Head Neck Surg 2004;130:486–9Google Scholar
16Nahas, Z, Tatlipinar, A, Limb, CJ, Francis, HW. Spontaneous meningoencephalocele of temporal bone. Arch Otolaryngol Head Neck Surg 2008;134:509–18Google Scholar
17Shetty, PG, Shroff, MM, Kirtane, MV, Karmarker, SS. Cerebrospinal fluid otorhinorrhea in patients with defects through the lamina cribrosa of the internal auditory canal. AJNR Am J Neuroradiol 1997;18:478–81Google Scholar
18da Cruz, MJ, Ahmed, SM, Moffat, DA. An alternative method for dealing with cerebrospinal fluid fistulae in inner ear deformities. Am J Otol 1998;19:288–91Google Scholar
19Kutz, JW, Husain, IA, Isaacson, B, Roland, PS. Management of spontaneous cerebrospinal fluid otorrhea. Laryngoscope 2008;118:2195–9Google Scholar
20Brown, NE, Grundfast, KM, Jabre, A, Megerian, CA, O'Malley, BW, Rosenberg, SI. Diagnosis and management of spontaneous cerebrospinal fluid middle ear effusion and otorrhea. Laryngoscope 2004;114:800–5Google Scholar
21Ahren, C, Thulen, CA. Lethal intracranial complications following inflation in the external auditory canal in treatment of serous otitis media and due to defects in the petrous bone. Acta Otolaryngol 1965;60:407–21Google Scholar
22Kapur, TR, Bangash, W. Tegmental and petromastoid defects in temporal bone. J Laryngol Otol 1986;100:1129–32Google Scholar
23Gacek, RR, Gacek, MR, Tart, R. Adult spontaneous cerebrospinal fluid otorrhea: diagnosis and management. Am J Otol 1999;20:770–6Google Scholar
24Aristegui, M, Falcioni, M, Saleh, E, Taibah, A, Russo, A, Landolfi, M. Meningoencephalic herniation into the middle ear: a report of 27 cases. Laryngoscope 1995;105:513–18Google Scholar
25Merchant, SN, McKenna, MJ. Neurotologic manifestations and treatment of multiple spontaneous tegmental defects. Am J Otol 2000;21:234–9Google Scholar
26Gubbels, SP, Selden, NR, Delashaw, JB Jr, McMenomey, SO. Spontaneous middle fossa encephalocele and cerebrospinal fluid leakage: diagnosis and management. Otol Neurotol 2007;28:1131–9Google Scholar
27Stone, JA, Castillo, M, Neelon, B, Mukherji, SK. Evaluation of CSF leaks: high-resolution CT compared with contrast-enhanced CT and radionuclide cisternography. AJNR Am J Neuroradiol 1999;20:706–12Google Scholar
28Montgomery, WW. Translabyrinthine resection of the small acoustic neuroma. Arch Otolaryngol 1969;89:135–41Google Scholar
29Adkins, WY, Osguthorpe, JD, Charleston, SC. Mini-craniotomy for management of CSF otorrhea from tegmen defects. Laryngoscope 1983;93:1038–40Google Scholar
30Kveton, JF, Goravalingappa, R. Elimination of temporal bone cerebrospinal fluid otorrhea using hydroxyapatite cement. Laryngoscope 2000;110:1655–9Google Scholar
31Pelosi, S, Bederson, JB, Smouha, EE. Cerebrospinal fluid leaks of temporal bone origin: selection of surgical approach. Skull Base 2010;20:253–9Google Scholar
32Manolidis, S. Dural herniations, encephaloceles: an index of neglected chronic otitis media and further complications. Am J Otolaryngol 2002;23:203–8Google Scholar