Cerebrospinal fluid leaks and encephaloceles of temporal bone origin: nuances to diagnosis and management.

Autor: Jeevan DS; Department of Neurosurgery, New York Medical College, Valhalla, New York, USA. Electronic address: dhruve.jeevan@me.com., Ormond DR; Department of Neurosurgery, New York Medical College, Valhalla, New York, USA., Kim AH; Department of Otolaryngology, New York Medical College, Valhalla, New York, USA., Meiteles LZ; Department of Otolaryngology, New York Medical College, Valhalla, New York, USA., Stidham KR; Department of Otolaryngology, New York Medical College, Valhalla, New York, USA., Linstrom C; Department of Otolaryngology, New York Medical College, Valhalla, New York, USA., Murali R; Department of Neurosurgery, New York Medical College, Valhalla, New York, USA.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2015 Apr; Vol. 83 (4), pp. 560-6. Date of Electronic Publication: 2014 Dec 13.
DOI: 10.1016/j.wneu.2014.12.011
Abstrakt: Objective: Temporal bone encephalocele has become less common as the incidence of chronic mastoid infection and surgery for this condition has decreased. As a result, the diagnosis is often delayed, and the encephalocele is often an incidental finding. This situation can result in serious neurologic complications with patients presenting with cerebrospinal fluid leak and meningitis. We review the occurrence of, characteristics of, and repair experience with temporal encephaloceles from 2000-2012.
Methods: We conducted a retrospective review of 32 patients undergoing combined mastoidectomy and middle cranial fossa craniotomy for the treatment of temporal encephalocele.
Results: The diagnosis of temporal encephalocele was made in all patients using high-resolution temporal bone computed tomography and magnetic resonance imaging. At the time of diagnosis, 12 patients had confirmed cerebrospinal fluid leak; other common presenting symptoms included hearing loss and ear fullness. Tegmen defect was most commonly due to chronic otitis media (n = 14). Of these patients, 8 had undergone prior mastoidectomy, suggesting an iatrogenic cause. Other etiologies included radiation exposure, congenital defects, and spontaneous defects. Additionally, 2 patients presented with meningitis; 1 patient had serious neurologic deficits resulting from venous infarction.
Conclusions: The risk of severe neurologic complications after the herniation of intracranial contents through a tegmen defect necessitates prompt recognition and appropriate management. Computed tomography and magnetic resonance imaging aid in definitive diagnosis. A combined mastoid/middle fossa approach allows for sustainable repair with adequate exposure of defects and support of intracranial contents.
(Copyright © 2015 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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