Challenges in the Management of Symptomatic Fallopian Canal Meningoceles: A Multicenter Case Series and Literature Review.

Autor:	Filip P; Department of Otolaryngology-Head and Neck Surgery, The Mount Sinai Hospital., Chiang H; Columbia University Vagelos College of Physicians and Surgeons, New York, NY., Goldberg A; Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, VA., Khorsandi AS; New York Eye and Ear of Mount Sinai., Moonis G; CUMC Division of Neuroradiology, Columbia University Medical Center, New York, NY., Moody Antonio SA; Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, VA., Wanna G; Department of Otolaryngology-Head and Neck Surgery, The Mount Sinai Hospital., Cosetti M
Jazyk:	angličtina
Zdroj:	Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology [Otol Neurotol] 2024 Apr 01; Vol. 45 (4), pp. 434-439.
DOI:	10.1097/MAO.0000000000004155
Abstrakt:	Objective: To describe the presentations, the diagnosis, our treatment approaches, and the outcomes for 11 patients with fallopian canal meningocele (FCM). Study Design Multicenter: Retrospective case series. Setting: Tertiary referral centers. Patients: Patients (N = 11) with radiographically or intraoperatively identified, symptomatic FCM. Interventions: Surgical repair of cerebrospinal fluid (CSF) leak and meningocele versus observation. Main Outcome Measures: Presentation (including symptoms, radiographic imaging, and comorbidities), management (including surgical approach, technique for packing, use of lumbar drain), clinical outcomes (control of CSF leak, meningitis, facial nerve function), and revision surgery. Results: Patients presented with spontaneous CSF leak (n = 7), conductive (N = 11) and sensorineural hearing loss (n = 3), nonpositional intermittent vertigo (n = 3), headaches (n = 4), and recurrent meningitis (n = 1). Risk factors in our series included obesity (n = 4), Chiari 1 malformation (n = 1), and head trauma (n = 2). Noncontrast computed tomography of the temporal bone and magnetic resonance imaging were positive for FCM in 10 patients. Eight patients were managed surgically via a transmastoid approach (n = 4), combined transmastoid and middle fossa (N = 3), or middle fossa alone (n = 1); three were managed conservatively with observation. Postoperative complications included worsened facial nerve palsy (n = 1), recurrent meningitis (n = 1), and persistent CSF leak that necessitated revision (n = 1). Conclusions: Facial nerve meningoceles are rare with variable presentation, often including CSF otorrhea. Management can be challenging and guided by symptomatology and comorbidities. Risk factors for FCM include obesity and head trauma, and Chiari 1 malformation may present with nonspecific otologic symptoms, in some cases, meningitis and facial palsy. Layered surgical repair leads to high rates of success; however, this may be complicated by worsening facial palsy. Competing Interests: Conflicts of interest: No relevant conflicts of interest were reported by any author. (Copyright © 2024, Otology & Neurotology, Inc.)
Databáze:	MEDLINE
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