Iatrogenic inner ear dehiscence associated with lateral skull base surgery: a systematic analysis of drilling injuries and their causal factors

Ben‐Shlomo, Nir; Jayender, Jagadeesan; Guenette, Jeffrey P.; Corrales, C. Eduardo

doi:10.1007/s00701-023-05695-3

Cited by 1 publication

(3 citation statements)

References 23 publications

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“…In addition to poor hearing outcomes, any breach to the vestibular labyrinth can lead to vertigo, tinnitus, and other debilitating third window symptoms. (8)(9)(10) When viewed chronologically, results from this cohort suggest the rates of inner ear dehiscence are increasing. Between the years 1998-2000, the greatest number of vestibular schwannoma resections were completed but the incidence of confirmed dehiscence was 12%, whereas in recent years, incidence rates of confirmed inner ear breaches are rising to above 30%.…”

Section: Identifying the Injurymentioning

confidence: 85%

“…In the case where a breach of the inner ear is found, immediate application of bone wax can be useful to avoid any excessive leak of labyrinthine fluid, and may negate the need for a secondary operation to alleviate third window symptomatology. (8)(9)(10) In only 378 cases (32.8%) were we able to evaluate the integrity of the temporal bone with postoperative CT, and the vast majority of these imaging studies were ordered with indications unrelated to the inner ear. This suggests that there is a lack of assessment of the inner ear following vestibular schwannoma surgery using CT imaging.…”

Section: Identifying the Injurymentioning

confidence: 99%

“…When injured iatrogenically, the inner ear has been reported to cause hearing loss as well as other third window phenomena including autophony and Tullio phenomena (vertigo and nystagmus induced by loud noises). Recent attention has been drawn to postoperative hearing loss and third window symptomatology after breaches of the inner ear from lateral skull base surgery (8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

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Inner Ear Breaches from Vestibular Schwannoma Surgery: Revisiting the Incidence of Otologic Injury from Retrosigmoid and Middle Cranial Fossa Approaches

Ben-Shlomo,

Rahimi,

Abunimer

et al. 2024

Otol Neurotol

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Objective To assess the rate of iatrogenic injury to the inner ear in vestibular schwannoma resections. Study Design Retrospective case review Setting Multiple academic tertiary care hospitals. Patients Patients who underwent retrosigmoid or middle cranial fossa approaches for vestibular schwannoma resection between 1993 and 2015. Intervention Diagnostic with therapeutic implications. Main Outcome Measure Drilling breach of the inner ear as confirmed by operative note or postoperative computed tomography (CT). Results 21.5% of patients undergoing either retrosigmoid or middle fossa approaches to the internal auditory canal were identified with a breach of the vestibulocochlear system. Because of the lack of postoperative CT imaging in this cohort, this is likely an underestimation of the true incidence of inner ear breaches. Of all postoperative CT scans reviewed, 51.8% had an inner ear breach. As there may be bias in patients undergoing postoperative CT, a middle figure based on sensitivity analyses estimates the incidence of inner ear breaches from lateral skull base surgery to be 34.7%. CONCLUSIONS A high percentage of vestibular schwannoma surgeries via retrosigmoid and middle cranial fossa approaches result in drilling breaches of the inner ear. This study reinforces the value of preoperative image analysis for determining risk of inner ear breaches during vestibular schwannoma surgery and the importance of acquiring CT studies postoperatively to evaluate the integrity of the inner ear.

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Section: Identifying the Injurymentioning

confidence: 85%

Section: Identifying the Injurymentioning

confidence: 99%