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

Abstract

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.

Skull Base Repair following Resection of Vestibular Schwannoma: A Systematic Review (Part 2: The Translabyrinthine Approach)

“…Most studies were retrospective (39/43), and all were case series. Four studies had at least one arm which was prospective [15][16][17][18] . Twelve out of 43 studies compared different techniques or materials.…”

“…Several studies reported an onlay technique to seal the dura, employing autologous grafts, xenografts and synthetic dural substitutes. 17,21,22,25,42,[47][48][49][50] Autologous onlays consisted of fascia grafts, harvested either from the abdomen or thigh. 17,22,25,42,48,51 Variations in the autologous onlay technique centred around the size of the graft used, ranging from slightly larger than the dural defect to a 'peri cranial graft basket' 47 .…”

“…17,21,22,25,42,[47][48][49][50] Autologous onlays consisted of fascia grafts, harvested either from the abdomen or thigh. 17,22,25,42,48,51 Variations in the autologous onlay technique centred around the size of the graft used, ranging from slightly larger than the dural defect to a 'peri cranial graft basket' 47 . Advantages of autologous grafts include their cost profile, universal availability, and high compatibility with the local tissue environment, while drawbacks include donor site-related complications and increased operative times.…”

“…19 Twenty-one out of 25 studies reported that the The ET could be occluded (or packed), or not treated at all. [15][16][17][18][19][20]23,[25][26][27][28]31,32,34,35,36,38,41,49,[55][56][57][58] Two studies analysed the impact of ET closure on CSF rates, both concluding ET packing did not influence CSF leak rates. 19,23 Considering the materials used to pack the eustachian tube, the many studies reported the use of muscle, typically harvested from the temporalis or from the sternocleidomastoid.…”

“…19,23 Considering the materials used to pack the eustachian tube, the many studies reported the use of muscle, typically harvested from the temporalis or from the sternocleidomastoid. [15][16][17][18][19][20]23,[25][26][27]31,32,36,38,56,58 Muscle was combined with either fascia 19,20,23,26,58 , oxidised cellulose (Surgicel) 17,19,[25][26][27]36,38 or tissue glue. 16,17,56 Other alternatives to muscle grafts for ET packing were: polytetrafluoroethylene and carbon filaments (Proplast) 19 , high molecular weight polyethylene (Plastipore) 19 , surgicel 19,41 , dry periosteum 17,32,34,55,57 , or the incus.…”