Spontaneous resolution of cerebrospinal fluid otorrhoea in a patient with a Hyrtl's fissure

Brar, Rondeep; Vijendren, Ananth; Salam, Mohamed A. Abd El; Picken, Gary

doi:10.1017/s0022215115001206

Cited by 4 publications

(1 citation statement)

References 10 publications

(28 reference statements)

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“…A review of the literature for all spontaneous congenital perilabyrinthine CSF leaks identified 19 additional cases from 16 publications which met inclusion criteria for each review 3,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] (Table 1). Of all available data, the average age at first clinical manifestation of all CSF fistulas was 7 years (range, 1-25 years) and the average age at diagnosis of all fistulas was 10 years (range, 2-25 years).…”

Section: Literature Reviewmentioning

confidence: 99%

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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Section: Literature Reviewmentioning

confidence: 99%

Spontaneous Congenital Perilabyrinthine Cerebrospinal Fluid Fistulas

Lovin

Appelbaum

Makoshi

et al. 2021

Ann Otol Rhinol Laryngol

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Hyrtl’s fissures in cochlear implant surgery

Xie

Harris

2020

Cochlear Implants International

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Cerebrospinal Fluid Otorrhea After a Routine Tympanostomy Tube Placement: A Review of the Literature on Hyrtl Fissure

et al. 2022

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Objective: To review the literature on Hyrtl fissure (HF) and contribute our experience with a 2-year old who developed cerebrospinal fluid (CSF) otorrhea during routine tympanostomy tube placement. Methods: Data Sources: Pubmed and Google Scholar searches were conducted of articles in the English language literature from all time periods using the words Hyrtl, Hyrtl’s fissure, HF, and tympanomeningeal fissure. Study Selection: All relevant articles were reviewed to identify cases of HF. Results: Data Extraction: Nineteen cases, including ours, are described. Patient characteristics, method(s) of diagnosis and repair, and outcomes are reported. Computed tomography and intraoperative endoscopic images from our case are included. Presentation is more common in children (66.7% of cases where age was stated, n = 10) than in adults (33.3%, n = 5), and is most commonly unilateral (89.5%, n = 17). Cerebrospinal fluid otorrhea was the most common presentation. Six were discovered after tympanostomy tube placements while 3 were identified during cochlear implant work-up or after device failure. Surgical approaches described include endaural, transcanal, retrosigmoid, postauricular, and posterior fossa endoscopic. Multiple materials including bone wax, bone pate, fascia, muscle, and tissue sealant have been used. Our case describes an endoscopic repair in a child, which was successful at a 2-year follow-up. Data Synthesis: The small number of cases limits the utility of statistical analysis (n = 19). Conclusions: Hyrtl fissure is a rare but important entity that may be discovered when routine procedures have unexpected results. Hyrtl fissure should be included in the differential diagnosis when there is persistent clear otorrhea after a tympanostomy tube, cochlear implant misinsertion, meningitis, or unexplained middle ear effusion in an adult.

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Spontaneous resolution of cerebrospinal fluid otorrhoea in a patient with a Hyrtl's fissure

Abstract: A literature search indicated this to be the first case with such a resolution without the need for any intervention.

Cited by 4 publications

References 10 publications

Spontaneous Congenital Perilabyrinthine Cerebrospinal Fluid Fistulas

Spontaneous Congenital Perilabyrinthine Cerebrospinal Fluid Fistulas

Hyrtl’s fissures in cochlear implant surgery

Cerebrospinal Fluid Otorrhea After a Routine Tympanostomy Tube Placement: A Review of the Literature on Hyrtl Fissure

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