Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale · 2011
Eustachian tube obliteration in translabyrinthine vestibular schwannoma excision: cerebrospinal fluid rhinorrhea and middle ear status.
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Saliba Issam, Shinghal Tulika, Nehme Jade, Dufour Jean-Jacques
Аннотация
OBJECTIVES: To assess the incidence of cerebrospinal fluid (CSF) rhinorrhea by systematic eustachian tube (ET) obliteration at the time of a translabyrinthine vestibular schwannoma (VS) excision and to evaluate its effect on the middle ear and on the tympanic membrane and if it is well tolerated by patients.
STUDY DESIGN: Retrospective study.
SETTING: Tertiary care centre.
PATIENTS: Group 1 (57 patients) and group 2 (87 patients) underwent translabyrinthine VS excision with and without systematic ET obliteration, respectively.
MAIN OUTCOME MEASURES: Petrous apex pneumatization level and postoperative CSF leak were evaluated. Group 1 patients had a late postoperative otologic examination, tympanometric test, Valsalva manoeuvre, and ear symptom evaluation.
RESULTS: There were six cases of CSF rhinorrhea in group 2, whereas no cases were observed in group 1 (p = .043), despite its larger tumour grade (p = .002). In group 2, CSF rhinorrhea was absent at pneumatization level 1. Three of six CSF rhinorrhea cases developed meningitis. None of the 27 tested patients of group 1 demonstrated a tympanic membrane retraction or a positive Valsalva manoeuvre. Tympanometry showed a type A curve (2 patients), a type As curve (14 patients), and a type B curve (11 patients). Air volumes and air pressures of the operated ears were lower than those of the nonoperated ears (p < .001).
CONCLUSION: Patients of group 1 tolerated the procedure well, with preserved tympanic membrane compliance. Bidirectional air exchange throughout a normal middle ear mucosa explains this fact. We recommend obliteration of both the petrous apex cells and ET in all cases of petrous apex pneumatization levels 2 to 4.
STUDY DESIGN: Retrospective study.
SETTING: Tertiary care centre.
PATIENTS: Group 1 (57 patients) and group 2 (87 patients) underwent translabyrinthine VS excision with and without systematic ET obliteration, respectively.
MAIN OUTCOME MEASURES: Petrous apex pneumatization level and postoperative CSF leak were evaluated. Group 1 patients had a late postoperative otologic examination, tympanometric test, Valsalva manoeuvre, and ear symptom evaluation.
RESULTS: There were six cases of CSF rhinorrhea in group 2, whereas no cases were observed in group 1 (p = .043), despite its larger tumour grade (p = .002). In group 2, CSF rhinorrhea was absent at pneumatization level 1. Three of six CSF rhinorrhea cases developed meningitis. None of the 27 tested patients of group 1 demonstrated a tympanic membrane retraction or a positive Valsalva manoeuvre. Tympanometry showed a type A curve (2 patients), a type As curve (14 patients), and a type B curve (11 patients). Air volumes and air pressures of the operated ears were lower than those of the nonoperated ears (p < .001).
CONCLUSION: Patients of group 1 tolerated the procedure well, with preserved tympanic membrane compliance. Bidirectional air exchange throughout a normal middle ear mucosa explains this fact. We recommend obliteration of both the petrous apex cells and ET in all cases of petrous apex pneumatization levels 2 to 4.