1/14. Tegmental defects and cerebrospinal fluid otorrhea.Congenital tegmental defects that present as unsuspected cerebrospinal fluid (CSF) otorrhea are diagnostic and therapeutic challenges. We reviewed 5 such patients to determine an optimal strategy for evaluation. Five patients presented with watery otorrhea, 4 of them after ventilation tube placement, and only 1 with rhinorrhea. The preoperative analysis of middle ear effusion for beta(2)-transferrin was positive in 2/4, equivocal in 1/4 and false negative in 1/4. Computerized tomography (CT) revealed nonspecific tegmental defects in all 5 patients. magnetic resonance imaging (MRI) demonstrated meningoencephalocele in 3/5 and dural irregularity in 1/5. Tegmental defects were confirmed at surgery in all cases, demonstrating meningocele or arachnoid granulations in 2/5 and encephalocele in 2/5 patients. We recommend a combination of beta(2)-transferrin analysis to verify CSF, high resolution CT (axial and coronal planes) to diagnose tegmental defects, and MRI (multiplanar) to evaluate the type of herniation. A combination mastoid and middle fossa approach for definitive repair is suggested.- - - - - - - - - - ranking = 1keywords = herniation, meningocele (Clic here for more details about this article) |
2/14. A case of meningoencephalic herniation of the temporal bone.A case of cerebrospinal fluid leakage from a meningoencephalic herniation of the temporal bone is presented. Computed tomography and magnetic resonance imaging were useful for a diagnosis of meningoencephalic herniation. After surgical treatment, no recurrence was observed during a 6-month follow-up period.- - - - - - - - - - ranking = 3.2265891883502keywords = herniation (Clic here for more details about this article) |
3/14. Spontaneous cerebrospinal fluid otorrhoea: case report and literature review.Cerebrospinal fluid otorrhoea may occur through the temporal bone both in children and adults. In children it is generally associated with labyrinthine malformations and usually presents with hearing loss in a child with recurrent meningitis. In adults it is sequel to direct head injury, otologic or neurotologic surgery or infection. More rarely this pathology is described as being "spontaneous", occurring without any history of trauma, surgery or infection. Spontaneous cerebrospinal fluid otorrhoea in adults may present with dull symptoms such as a blocked ear or short term conductive hearing-loss. The anatomic site of this fistula is the tegmen tympani which may have a microscopic or macroscopic bone deficiency or sometimes even a "silent" meningoencephalic herniation. The authors describe a case of spontaneous cerebrospinal fluid otorrhoea occurring in an adult patient with bilateral absence of the tegmen tympani and review the literature regarding this specific. They suggest that its actual occurrence may be underestimated. Special attention should be given to adult patients with recurrent or persistent middle ear effusion. Any suspicion should be followed by meticulous imaging and surgical exploration since this may be a lifethreatnening situation.- - - - - - - - - - ranking = 0.53776486472504keywords = herniation (Clic here for more details about this article) |
4/14. diagnosis and management of spontaneous cerebrospinal fluid-middle ear effusion and otorrhea.OBJECTIVES/HYPOTHESIS: Spontaneous leak of cerebrospinal fluid (CSF) into the middle ear can occur in adults without a history of temporal bone trauma or fracture, meningitis, or any obvious cause. Therefore, clues may be lacking that would alert the otolaryngologist that fluid medial to an intact eardrum, or fluid emanating from an eardrum perforation, is likely to be CSF fluid. A review of relevant medical literature reveals that herniation of the arachnoid membrane through a tegmen defect may be congenital, or CSF leak may occur when dynamic factors (i.e., brain pulsations or increases in intracranial pressure) produce a rent in the arachnoid membrane. Because tegmen defects may be multiple rather than single, identifying only one defect may not be sufficient for achieving definitive repair. Data on nine cases of spontaneous CSF leak to the ear in adult patients from four medical centers are presented and analyzed to provide collective information about a disorder that can be difficult to diagnose and manage. STUDY DESIGN: Retrospective review of nine cases of spontaneous CSF middle ear effusion/otorrhea. RESULTS: The majority of patients presented with symptoms of aural fullness and middle ear effusion. Many developed suspicious clear otorrhea only after insertion of a tympanostomy tube. Two patients had multiple defects in the tegmen and dura, and five patients had meningoencephaloceles confirmed intraoperatively. Five patients underwent combined middle cranial fossa/transmastoid repair. Materials used in repair included temporalis fascia, free muscle graft, Oxycel cotton, calvarial bone, pericranium, bone wax, and fibrin glue. CONCLUSIONS: CSF middle ear effusion/otorrhea can develop in adults without a prior history of meningitis or head trauma or any apparent proximate cause. Although presenting symptoms can be subtle, early suspicion and confirmatory imaging aid in establishing the diagnosis. Because surgical repair by way of a mastoid approach alone can be inadequate if there are multiple tegmen defects, a middle fossa approach alone, or in combination with a transmastoid approach, should be considered in most cases.- - - - - - - - - - ranking = 0.53776486472504keywords = herniation (Clic here for more details about this article) |
5/14. Management of brain herniation and cerebrospinal fluid leak in revision chronic ear surgery.OBJECTIVES/HYPOTHESIS: brain herniation and cerebrospinal fluid (CSF) leakage into the middle ear and mastoid are rare but described complications of chronic ear disease. This paper will discuss the presentation and management of brain herniation and/or CSF leak encountered in revision chronic ear surgery. STUDY DESIGN: Retrospective chart review. methods: Twelve of 1,130 cases of revision chronic ear surgery in which brain herniation or CSF leak was diagnosed were identified and analyzed. RESULTS: Ten (83%) patients' initial diagnosis was tympanic membrane (TM) perforation with cholesteatoma and two (17%) with TM perforation without cholesteatoma. Initial revision procedures included one (8.3%) tympanoplasty with canal-wall-up mastoidectomy maintaining ossicular continuity, two (17%) tympanoplasties with canal-wall-down (CWD) mastoidectomies with ossicular chain reconstruction (OCR), and nine (75%) tympanoplasties with CWD mastoidectomies without OCR. Three (25%) required a second procedure, two (17%) a third, and one (8.3%) a fourth, finally resulting in four (33%) with an ossicular reconstruction and eight (67%) without. brain herniation and/or CSF leak were repaired by way of transmastoid and middle fossa approaches. Preoperative and postoperative pure-tone average air-bone gaps were statistically similar (33.1 and 28.1 dbHL, respectively; P = .464). CONCLUSIONS: brain herniation and/or CSF leak appear to be rare complications of surgery for revision chronic ear disease. Their management require adherence to the principles of establishing a safe ear with hearing restoration as a secondary goal.- - - - - - - - - - ranking = 4.8398837825253keywords = herniation (Clic here for more details about this article) |
6/14. Histopathology of spontaneous brain herniations into the middle ear.Two patients with spontaneous brain herniation into the middle ear have been operated on with a combined otoneurological approach. In case No. 1, two 2 x 3 mm arachnoid tissue herniations were found in the tegmen antri of the left ear. Six years later, a 8 x 9 mm mass consisting of prolapsed brain was removed from the right ear. The histological examination showed normal but disorganized nervous tissue. The surface consisted of middle ear mucosa or modified glial cells. More deeply numerous well preserved neurons and synapses were observed. In case No. 2, a 2 x 1 cm herniation was found in contact with the ossicles and the bony walls of the middle ear. The herniation consisted of partly degenerated nervous tissue which could explain the episode of temporal lobe seizure the patient experienced 8 years before surgery. In the world literature during the last 40 years, 29 cases of spontaneous or idiopathic brain herniation into the middle ear and mastoid have been reported. In 10, the herniations were multiple, as in our case No. 1. Case No. 1 is interesting also because the spontaneous brain herniation was bilateral.- - - - - - - - - - ranking = 5.9154135119754keywords = herniation (Clic here for more details about this article) |
7/14. brain herniation into the middle ear following temporal bone fracture.Otorrhea of leaked cerebrospinal fluid and meningitis in a 33-year-old male originated from an encephalic herniation into the middle ear following traumatic temporal bone fracture. CT demonstrated a mixed-type fracture consisting of a longitudinal fracture and a posterior oblique fracture of the left temporal bone. The left tegmen tympani was broken into a bellows-like shape and a bone splinter from it had stuck in the epitympanum at the level of the incus body. Surgery via a middle cranial fossa approach confirmed penetration of the brain tissue between the incus and lateral semicircular canal. The diagnosis and management of this condition are discussed in the context of a literature review.- - - - - - - - - - ranking = 2.6888243236252keywords = herniation (Clic here for more details about this article) |
8/14. cerebrospinal fluid otorrhea at myringotomy. A meningocele through a defect in the tegmen.Spontaneous cerebrospinal fistulae can simulate secretory otitis media or be discovered at myringotomy, but the diagnosis is frequently made after one or more episodes of meningitis. Congenital perilabyrinthine fistulae are extremely rare, and unlike translabyrinthine fistulae there is usually no sensorineural hearing loss. This is the first reported case of a congenital meningocele through the tegmen in a child. An 11-year-old boy presented with signs and symptoms which mimicked serous otitis media. A cerebrospinal fistula was produced at myringotomy and this was closed surgically via an endaural approach. A CT scan defined a defect in the tegmen tympani anterior to the superior semicircular canal.- - - - - - - - - - ranking = 2.3111756763748keywords = meningocele (Clic here for more details about this article) |
9/14. brain herniation into the middle ear: two idiopathic cases treated by a combined intracranial-mastoid approach.One hundred thirty-nine cases of brain herniation into the middle ear and mastoid have been reported in the world literature during the last 40 years. In 29 cases the herniation was idiopathic. In idiopathic cases, intermittent CSF otorhinorrhea, a history of intermittent "serous otitis media," and a conductive hearing loss were the main clinical findings. Polytomography or CT-scan revealed a tegmen antri or tympani defect in some patients. There are three surgical approaches for treatment of brain herniation into the middle ear: neurosurgical, otological, and combined.- - - - - - - - - - ranking = 3.7643540530753keywords = herniation (Clic here for more details about this article) |
10/14. Multiple use of benzoin as an aid in neurosurgical practice: the watertight benzoin dressing.The author presents a survey of his experience with the use of benzoin as an aid to prevent and to treat wound complications as: CSF leakage ruptured meningoceles, prevention of leakage and wound infections, during the use of external cranial drainage, indwelling catheters or implanted cannulas and electrodes. A few other handy uses are also mentioned.- - - - - - - - - - ranking = 0.46223513527496keywords = meningocele (Clic here for more details about this article) |
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