Surgical management of spontaneous cerebrospinal fistulas and encephaloceles of the temporal bone

Kutz, Joe Walter; Johnson, Andrew K.; Wick, Cameron C.

doi:10.1002/lary.27208

Cited by 46 publications

(59 citation statements)

References 35 publications

(61 reference statements)

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“…Literature has demonstrated that most patients who undergo sCSF‐L repair are obese 1,8,10,13,14,18,19 (Fig. 4).…”

Section: Discussionmentioning

confidence: 99%

“…Lastly, there were no infections using bone cement. Prior studies have noted the possibility of infection when using bone cement in the mastoid, although rates of infection were relatively low 14,26,39 . Specifically, Kutz et al utilized bone cement in 82.4% of 55 patients undergoing repair of sCSF‐L 14 ; one patient who underwent transmastoid repair of a posterior fossa defect developed an infection post‐operatively, which resolved after a return to the OR to clear granulation tissue off of the bone cement 14 .…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies have noted the possibility of infection when using bone cement in the mastoid, although rates of infection were relatively low 14,26,39 . Specifically, Kutz et al utilized bone cement in 82.4% of 55 patients undergoing repair of sCSF‐L 14 ; one patient who underwent transmastoid repair of a posterior fossa defect developed an infection post‐operatively, which resolved after a return to the OR to clear granulation tissue off of the bone cement 14 . Kveton et al utilized bone cement in repairing 13 sCSF‐L through a transmastoid approach, and reported one infection in a patient who pre‐operatively had chronic suppurative otitis media, concluding that this procedure should be avoided in the setting of active infection 39 …”

Section: Discussionmentioning

confidence: 99%

“…Nearly all temporal bone sCSF‐L occur through the tegmen (tympani or mastoideum) and through the temporal lobe dura. Posterior fossa plate leaks over the cerebellum are rare 14 . Surgical approaches to repair temporal bone sCSF‐L include middle cranial fossa (MCF) craniotomy, transmastoid and combined MCF/transmastoid approaches 4 .…”

Section: Introductionmentioning

confidence: 99%

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Middle Cranial Fossa Repair of Temporal Bone Spontaneous CSF Leaks With Hydroxyapatite Bone Cement

et al. 2020

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Objectives To determine the safety and effectiveness of the middle cranial fossa (MCF) approach in repairing spontaneous cerebrospinal fluid (sCSF) leaks. Study Design Retrospective cohort study. Methods Patient with sCSF leaks repaired by MCF approach between January 1, 2014 and August 31, 2019 were included. Demographic information, clinical and surgical findings, and postoperative outcomes were recorded. Results The cohort (n = 45) included 24 tegmen repairs by multilayer reconstruction using hydroxyapatite cement and 21 cases of multilayer repair without hydroxyapatite cement. Ten MCF repairs were performed on patients ≥65 years old. Twenty (53%) ears had multiple tegmen defects (range, 1–9 tegmen defects) and 78% of patients had ≥1 encephaloceles. All sCSF leaks were resolved with one surgical intervention. There were no major intracranial complications. Transient expressive aphasia occurred in 2 patients. Medical complications occurred in four patients. There were no short‐term postoperative CSF leaks with bone cement reconstruction and two postoperative leaks without bone cement. One resolved with lumbar drain (LD) and the other resolved without treatment. The average (SD) length of stay (LOS) with bone cement was shorter than in patients without bone cement (2.54 [0.83] days vs. 3.52 [1.99] days, P < .05). There have been no long‐term CSF leak recurrences with an average (SD) follow‐up of 13.5 (12.9) months (range 0.25–46 months). Conclusions MCF approach for sCSF repairs demonstrate efficacious outcomes, particularly with tegmen reconstruction using hydroxyapatite cement. The approach exhibited no serious adverse events and few complications requiring intervention. Therefore, MCF is a safe and effective approach to resolve sCSF leaks. Level of Evidence 3 Laryngoscope, 131:624–632, 2021

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“…Literature has demonstrated that most patients who undergo sCSF‐L repair are obese 1,8,10,13,14,18,19 (Fig. 4).…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Middle Cranial Fossa Repair of Temporal Bone Spontaneous CSF Leaks With Hydroxyapatite Bone Cement

et al. 2020

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“…Die Pathogenese der beidseitigen Otoliquorrhoe ist in unserem Fall nicht endgültig zu klären, jedoch kann eine tegmentale knöcherne Dehiszenz bereits ab einer Größe von 2 Millimeter als Schwachstelle durch chronische Inflammation im Sinne rezidivierender Mittelohrentzündungen eine mögliche Ursache darstellen. Die Therapie der spontanen Liquorleckage der Laterobasis ist chirurgisch und erfolgt klassischerweise über einen transmastoidalen oder trans-temporalen Zugang [7]. Bei der Liquorleckage der anterioren Schädelbasis stehen dem Chirurgen zusätzlich endonasal-endoskopische Therapieverfahren zur Verfügung [8].…”

Section: Diskussionunclassified

Rezidivierende beidseitige Paukenergüsse und Trommelfellperforation

et al. 2020

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Spaceflight-Associated Changes in the Opacification of the Paranasal Sinuses and Mastoid Air Cells in Astronauts

Inglesby

Antonucci

Spampinato

et al. 2020

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Head congestion is one of the most common somatic symptoms experienced by astronauts during spaceflight; however, changes in the opacification of the paranasal sinuses or mastoid air cells in astronauts have not been adequately studied.OBJECTIVES To quantify preflight to postflight changes in the opacification of the paranasal sinuses and mastoid air cells in Space Shuttle astronauts and International Space Station (ISS) astronauts and to assess whether there are differences between the 2 groups of astronauts. DESIGN, SETTING, AND PARTICIPANTSThis cohort study examined preflight and postflight head magnetic resonance images (MRIs) of 35 astronauts who had participated in either a short-duration (Յ30 days) Space Shuttle mission or a long-duration (>30 days) ISS mission and had undergone both preflight and postflight MRI. Images were obtained before and after spaceflight. Images were evaluated by 2 neuroradiologists blinded to which mission each astronaut had flown and to which images were preflight or postflight images. EXPOSURE Spaceflight on the Space Shuttle or the ISS. MAIN OUTCOMES AND MEASURES Measured outcomes included preflight to postflight changes in Lund-Mackay scores for the paranasal sinuses and in scores grading mastoid effusions. RESULTS Most astronauts in both the Space Shuttle group (n = 17; 15 men; mean [SD] age at launch, 47.7 [3.1] years) and the ISS group (n = 18; 14 men; mean [SD] age at launch, 48.6 [4.7] years) exhibited either no change or a reduction in paranasal sinus opacification as seen on postflight MRI scans (Space Shuttle group: 6 [35.3%] had no sinus opacification before or after spaceflight, 5 [29.4%] had less sinus opacification after spaceflight, 3 [17.6%] had the same amount of sinus opacification before and after spaceflight, and 3 [17.6%] had increased paranasal sinus opacification after spaceflight; ISS group: 8 [44.4%] had no sinus opacification before or after spaceflight, 4 [22.2%] had less sinus opacification after spaceflight, 1 (5.6%) had the same amount of sinus opacification before and after spaceflight, and 5 [27.8%] had scores consistent with increased paranasal sinus opacification after spaceflight). Long-duration spaceflight (ISS group) was associated with an increased risk of mastoid effusion relative to short-duration spaceflight (relative risk, 4.72; 95% CI, 1.2-18.5). Images were obtained a mean (SD) 287.5 (208.6) days (range, 18-627 days) prior to and 6.8 (5.8) days (range, 1-20 days) after spaceflight. Astronauts had undergone either a mean (SD) of 13.6 (1.6) days of spaceflight on the Space Shuttle (17 astronauts) or 164.8 (18.9) days on the ISS (18 astronauts). CONCLUSIONS AND RELEVANCEThis study found that exposure to spaceflight conditions on the ISS is associated with an increased likelihood for the formation of mastoid effusions. There was no association between exposure to spaceflight conditions and changes in paranasal sinus opacification. The limitations of this study include lack of information concerning medical history and mission-sp...

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Surgical management of spontaneous cerebrospinal fistulas and encephaloceles of the temporal bone

Abstract: 4 Laryngoscope, 128:2170-2177, 2018.

Cited by 46 publications

References 35 publications

Middle Cranial Fossa Repair of Temporal Bone Spontaneous CSF Leaks With Hydroxyapatite Bone Cement

Middle Cranial Fossa Repair of Temporal Bone Spontaneous CSF Leaks With Hydroxyapatite Bone Cement

Rezidivierende beidseitige Paukenergüsse und Trommelfellperforation

Spaceflight-Associated Changes in the Opacification of the Paranasal Sinuses and Mastoid Air Cells in Astronauts

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