Intracranial infection due to otitis media with a tegmen defect: Surgical approach
DOI:
https://doi.org/10.34631/sporl.773Keywords:
Tegmen defects, transmastoid approach, middle cranial fossa approach, combined approach, mastoidectomy.Abstract
Objectives: To report the experience of our department in the surgical approach of the patients admitted between 2012 and 2018 for intracranial infection of otogenic etiology, in the context of a tegmen defect.
Study Design: Retrospective, Case Series
Material and Methods: Pre-existing otological pathology, intracranial complication, surgical approach and its timing, materials used to correct the defect, as well as the follow-up time were evaluated.
Results: Twelve patients who underwent surgical treatment for intracranial infectious complications (meningitis / abscess / meningoencephalitis / septic venous thrombosis) were included. The most frequent etiology was cholesteatomatous chronic otitis media. The transmastoid approach was the most used. In two cases a combined approach with the collaboration of Neurosurgery was used. Only one case required revision surgery.
Conclusion: The correction of the infectious focus is crucial for the resolution of intracranial complication, and its early multidisciplinary approach is important. The transmastoid approach is a safe, familiar and highly effective option for the otolaryngologist.
References
Markou K, Goudakos J, Franco-Vidal V, Vergnolles V, Vignes JR, Darrouzet V. Spontaneous osteodural defects of the temporal bone: Diagnosis and management of 12 cases. Am J Otolaryngol. 2011 Mar-Apr;32(2):135-40. doi: 10.1016/j.amjoto.2009.12.003
Kim L, Wisely CE, Dodson EE. Transmastoid approach to spontaneous temporal bone cerebrospinal fluid leaks: hearing improvement and success of repair. Otolaryngol Head Neck Surg. 2014 Mar;150(3):472-8. doi: 10.1177/0194599813518173.
Marchioni D, Bonali M, Alicandri-Ciufelli M, Rubini A, Pavesi G, Presutti L. Combined approach for tegmen defects repair in patients with cerebrospinal fluid otorrhea or herniations: our experience. J Neurol Surg B Skull Base. 2014 Aug;75(4):279-87. doi: 10.1055/s-0034-1371524.
Braca JA, Marzo S, Prabhu VC. Cerebrospinal fluid leakage from tegmen tympani defects repaired via the middle cranial fossa approach. J Neurol Surg B Skull Base. 2013 Apr;74(2):103-7. doi: 10.1055/s-0033-1333616.
Juliano A, Ginat D, Moonis G. Imaging Review of the Temporal Bone: Part I. Anatomy and Inflammatory and Neoplastic Processes. Radiology. 2013 Oct; 269(1):17-33. doi: 10.1148/radiol.13120733.
Kapur TR. Tegmental and petromastoid defects in the temporal bone. J Laryngol Otol. 1986 Oct;100(10):1129-32. doi: 10.1017/s0022215100100702 .
Nelson RF, Gantz BJ, Hansen MR. The rising incidence of spontaneous cerebrospinal fluid leaks in the United States and the association with obesity and obstructive sleep apnea. Otol Neurotol. 2015 Mar;36(3):476-80. doi: 10.1097/MAO.0000000000000535.
Wahba H, Ibrhaim S, Youssef TA. Management of iatrogenic tegmen plate defects: Our clinical experience and surgical technique. Eur Arch Otorhinolaryngol. 2013 Sep;270(9):2427-31. doi: 10.1007/s00405-012-2260-8.
Rao A, Merenda D, Wetmore S. Diagnosis and management of spontaneous cerebrospinal fluid otorrhea. Otol Neurotol. 2005 Nov;26(6):1171-5.
