Hyrtl’s fissures in cochlear implant surgery

Xie, Chuang; Harris, Robert L.

doi:10.1080/14670100.2020.1823127

Cited by 2 publications

(1 citation statement)

References 14 publications

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“…Finally, an additional 6 cases of Hyrtl's fissure, one of which was bilateral, from 5 publications were identified which did not meet inclusion and exclusion criteria for the first review given either adult onset of CSF leak or no clinical evidence of CSF leak. 19,[23][24][25][26] Including the present case, there were 13 cases of Hyrtl's fissure throughout the literature (Table 2). Three (21%) fissures were diagnosed without clinical evidence of CSF fistula at presentation.…”

Section: Literature Reviewmentioning

confidence: 92%

Spontaneous Congenital Perilabyrinthine Cerebrospinal Fluid Fistulas

Lovin

Appelbaum

Makoshi

et al. 2021

Ann Otol Rhinol Laryngol

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Objectives: To report a recalcitrant spontaneous cerebrospinal fluid (CSF) fistula arising from multiple, anatomically-linked lateral skull base defects, and to review the available literature to determine optimal techniques for operative repair of congenital CSF fistulae. Methods: A patient with recurrent episodes of otologic meningitis was found to have a patent tympanomeningeal fissure, also known as a Hyrtl’s fissure, and internal auditory canal (IAC) diverticulum that communicated with the jugular bulb. A systematic review of the literature characterized all reports of spontaneous congenital perilabyrinthine CSF leaks, and all cases of Hyrtl’s fissures. Results: An 11-year-old female was referred for recurrent meningitis. Imaging demonstrated a fistulous connection between the middle ear and IAC diverticulum via the jugular foramen. Specifically, a Hyrtl’s fissure was identified, as well as demineralized bone around the jugular bulb. Obliteration of the fissure was initially performed, and a fistula reformed 4 months later. Multifocal CSF egress in the hypotympanum was identified on re-exploration, and middle ear obliteration with external auditory canal (EAC) overclosure was performed. A systematic review of the literature demonstrated 19 cases of spontaneous congenital perilabyrinthine CSF leaks. In total, 6 cases had multiple sources of CSF leak and 2 had history suggestive of intracranial hypertension. All of these noted cases demonstrated leak recurrence. Middle ear obliteration with EAC overclosure was successful in 4 recalcitrant cases. Conclusions: Repair of spontaneous congenital perilabyrinthine CSF leaks in cases demonstrating multiple sources of egress or signs of intracranial hypertension should be approached with caution. Middle ear obliteration with EAC overclosure may provide the most definitive management option for these patients, particularly if initial attempt at primary repair is unsuccessful.

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