Does Packing the Eustachian Tube Impact Cerebrospin al Fluid Rhinorrhea Rates in Translabyrinthine Vestibular Schwannoma Resections?

Jacob, Abraham; Bortman, Jared; Robinson, Lawrence L.; Yu, Lianbo; Dodson, Edward E.; Welling, D. Bradley

doi:10.1097/mao.0b013e31814619bd

Cited by 22 publications

(25 citation statements)

References 16 publications

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“…Many techniques have been described for reducing the incidence of CSF leakage: (1) tight suture of the cerebral dura mater closure area; (2) packing of the mastoidectomy defect with several strips of autologous abdominal fat graft tissue [33], or with other materials, such as polymethylmethacrylate, acrylic [34], and hydroxyapatite cement and titanium mesh [35], and (3) occlusion of the antrum, vestibulum, petrosal air cells, and Eustachian tube with bone wax [36,37]. According to our experience, middle ear exclusion is also an important precaution to avoid CSF leakage in case of highly pneumatized temporal bone.…”

Section: Discussionmentioning

confidence: 99%

Removal of Large or Giant Sporadic Vestibular Schwannomas via Translabyrinthine Approach: A Report of 115 Cases

Zhang

Wang

Huang

et al. 2012

ORL

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Background/Aims: The present study was a retrospective analysis of surgical outcomes of large or giant vestibular schwannomas (VSs) via a translabyrinthine approach (TLA). Methods: One hundred and fifteen sporadic large or giant VSs (maximal diameter in the cerebellopontine angle ≥31 mm) were operated via TLA between January 2001 and December 2010. We divided patients into two groups: cystic VS (CVS) and solid VS (SVS) group. The surgical outcomes were recorded and compared. Results: Total, near total, and subtotal tumor removal rate was 89.6, 7.8, and 2.6%, respectively. The near total removal rate in CVS was higher than that in SVS (16.7 vs. 3.8%). The anatomical facial nerve (FN) integrity was preserved in 101 patients (87.8%). More FNs in CVS were interrupted (22.2%). There were 29.6, 56.5, and 13.9% of patients who had a short-term (1 month) FN function of House-Brackmann grade I or II, III or IV, and V or VI, respectively. The CVS had worse FN function than the SVS group. The mortality rate was 0.9%. Cerebrospinal fluid leakage occurred in 8 patients (7.0%). Four (3.5%) patients had recurrence. Conclusions: Cyst formation is a crucial factor for surgical outcome of VS. With near total or subtotal tumor removal, worse functional outcomes in large or giant CVSs should be foreseen.

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Section: Discussionmentioning

confidence: 99%

Removal of Large or Giant Sporadic Vestibular Schwannomas via Translabyrinthine Approach: A Report of 115 Cases

Zhang

Wang

Huang

et al. 2012

ORL

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“…Current literature perpetuates the existing discord, as the efficacy of ET obliteration is inconsistent from one study to another. Whereas some have shown that a meticulous enlarged translabyrinthine approach [8,9] or a Palva flap technique [10] have the potential to reduce CSF leaks, others report no difference in CSF rhinorrhea rates even though they obliterated the ET [28] . In our previous study, we found a statistically significant decrease in the rate of CSF leaks in patients who had undergone ET obliteration as compared to people who did not [22] .…”

Section: Discussion Eustachian Tube Obliterationmentioning

confidence: 99%

Eustachian Tube Obliteration and its Effect on Rhinoliquorrhea in Translabyrinthine Vestibular Schwannoma Excision

Moderie

Maniakas²,

Moumdjian³

et al. 2017

Int Adv Otol

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OBJECTIVE:Rhinoliquorrhea is defined as a cerebrospinal fluid leakage from the nose. Our objective in this study is to determine the reduction of rhinoliquorrhea rates by Eustachian tube (ET) obliteration in the context of a translabyrinthine approach performed following vestibular schwannoma (VS) excision. MATERIALS and METHODS:This is a prospective study achieved in a tertiary-care center where the chart review revealed 94 VS operated by the translabyrinthine approach between 2009 and 2015. There were 40 males and 54 females aged from 28-76 years. The only exclusion criterion was a previous history of cranial surgery. ET obliteration was systematically executed when the petrous apex pneumatization level was at least 2 of 4. Our main outcome measure was the development of rhinoliquorrhea. RESULTS:Eighty-eight patients underwent ET obliteration and were followed for an average of 2.6±1.2 years. Rhinoliquorrhea was reported in 1.14% of the patients having had an ET obliteration. When compared to our previous sample of patients operated with a translabyrinthine approach, it represents a reduction of 84%. CONCLUSION:Obliteration of the ET is a fast and simple procedure that reduces the rate of rhinoliquorrhea. We therefore recommend its use, specifically in cases of petrous apex pneumatization levels 2-4.

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“…Although the injured eustachian tube can be plugged off to prevent the paradoxical CSF rhinorrhea, several other side effects in relation to the acoustic conductance and middle-ear mucus retention have been reported, reflecting the physiological compromise of this conduit. 26,27 In addition, there remains a cohort of cases in which the surgical endeavors such as packing the eustachian tube, fail to prevent the CSF rhinorrhea. 27 The present microanatomical study was thus guided by the philosophy of preserving the physiological integrity of anatomical structures as much as possible.…”

Section: Glasscock To Rhomboid or Rhomboid To Glasscock?mentioning

confidence: 99%

“…26,27 In addition, there remains a cohort of cases in which the surgical endeavors such as packing the eustachian tube, fail to prevent the CSF rhinorrhea. 27 The present microanatomical study was thus guided by the philosophy of preserving the physiological integrity of anatomical structures as much as possible. The mean distance from the medial carotid wall midpoint to the medial-most point on the eustachian tube, in our study was 6.35 AE 0.58 mm (range, 5.4 to 7.1 mm) ( Table 1).…”

Section: Glasscock To Rhomboid or Rhomboid To Glasscock?mentioning

confidence: 99%

Petrous Carotid Exposure with Eustachian Tube Preservation: A Morphometric Elucidation

Banerjee¹,

Thakur²,

Ezer³

et al. 2011

Skull Base

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Inadvertent injury to eustachian tube leading to cerebrospinal fluid rhinorrhea is a known complication associated with drilling of Glasscock's triangle to expose the horizontal petrous internal carotid artery (ICA) for management of difficult tumors (especially malignant) or aneurysms at the cranial base. Contrary to the usual approach, we hypothesize that a ''medial-to-lateral'' approach to Glasscock's triangle drilling will minimize eustachian tube injury. Four formalin-fixed human cadaveric heads were dissected, and underwent appropriate morphometric analysis; yielding a total of eight datasets. The diameter of the horizontal petrous ICA exposed was 4.7 AE 0.9 mm (range, 3.8 to 5.6 mm).The mean distance from the medial carotid wall midpoint to the medialmost point on the eustachian tube was 6.35 AE 0.58 mm (range, 5.4 to 7.1 mm), yielding a ''safety zone'' for eustachian tube, ranging 0.2 to 1.9 mm lateral to the lateral carotid wall. With the medial-to-lateral approach, the eustachian tube remained preserved in all the specimens. The results of our study provide a practical, consistent, and safe method of maximizing horizontal petrous carotid artery exposure while minimizing the eustachian tube injury. KEYWORDS: Petrous, carotid, eustachian tube, morphometricThe last two decades have seen tremendous evolution in skull base surgery. Even though skull base surgical techniques have evolved over time, the postoperative morbidity and mortality associated with them are a major area of concern for the surgeon considering quality of life as an important outcome parameter gauging the operative success.Surgical management of complex aneurysms, vascular lesions, and tumors encasing or invading the internal carotid artery (ICA) located at the skull base necessitates the exposure of the horizontal segment of the ICA located in the petrous bone. The most popular approach described to achieve the latter is the middle fossa approach or its variants. [1][2][3][4][5] The complex anatomy * These authors have contributed equally in this study.

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Does Packing the Eustachian Tube Impact Cerebrospin al Fluid Rhinorrhea Rates in Translabyrinthine Vestibular Schwannoma Resections?

Abstract: Cerebrospinal fluid leak rates were similar in patients undergoing TL, SO, and MCF approaches, and CSF rhinorrhea was not decreased by ET packing. Patients whose ETs are packed with Proplast are at risk for extrusion and otorrhea years after their initial VS resection.

Cited by 22 publications

References 16 publications

Removal of Large or Giant Sporadic Vestibular Schwannomas via Translabyrinthine Approach: A Report of 115 Cases

Removal of Large or Giant Sporadic Vestibular Schwannomas via Translabyrinthine Approach: A Report of 115 Cases

Eustachian Tube Obliteration and its Effect on Rhinoliquorrhea in Translabyrinthine Vestibular Schwannoma Excision

Petrous Carotid Exposure with Eustachian Tube Preservation: A Morphometric Elucidation

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