Kronik otit veya cerrahisi sonrasında oluşan dural kemik defektleri ve ensefalosel
Amaç: Radikal mastoidektomi veya açık kavite timpanoplasti yapılan olgularda dural kemik defekti ve ensefalosel sıklığı arafltırıldı.Hastalar ve Yöntemler: Çalıflmada 182 olguda yapılan 190 açık kavite n=101 veya radikal mastoidektomi n=89 ameliyatında dural kemik defekti ve ensefalosel geliflimi retrospektif olarak arafltırıldı. Kontrollerde olguların otomikroskobikmuayeneleri yapıldı. Ameliyat notunda veya muayenededural kemik defekti saptanan olgularda temporal kemiğinaksiyel ve koronal planda bilgisayarlı tomografi incelemesi yapıldı. Ensefaloselden flüphelenilen olgularda ek olarak manyetik rezonans görüntülemeye baflvuruldu.Bulgular: Ameliyat sırasında 17 olguda dural kemik defekti saptandı; 14 olguda defektin kronik otite bağlı olufltuğu belirlendi. Lateral sinüs tromboflebiti nedeniyle ameliyat edilen üç olguda posterior fossada kemik defekti iyatrojenik olarak oluflmufltu. Defekt, en sık mastoid tegmende %41 bulundu. En yüksek oranda %84 karflılaflılanetyolojik neden kolesteatom idi. Lateral sinüs tromboflebiti nedeniyle radikal mastoidektomi ve lateral sinüs obliterasyonu yapılan bir olguda ensefalosel saptandı. İki olguda defekte komflu alanda ensefalomalazi belirlendi.Sonuç: Kronik otit nedeniyle geliflen dural kemik defektiseyrek değildir ve en sık görülen neden kolesteatomdur.Ensefalosel geliflimini önlemek için dura laserasyonları sugeçirmez sıkılıkta tamir edilmelidir
Anahtar Kelimeler:
Beyin apsesi/etyoloji, beyin-omurilik sıvısı otoresi/etyoloji, kolesteatom/tanı/radyografi, dura mater, kulak, orta/cerrahi, ensefalosel/tanı/etyoloji, manyetik rezonans görüntüleme, mastoid/cerrahi, otitis media/cerrahi/komplikasyon, temporal kemik/anormallik/cerrahi/radyografi, bilgisayarlı tomografi
Dural bone defects and encephalocele associated with chronic otitis media or its surgery
Objectives: We investigated the incidence of dural bone defects and encephalocele follovving radical mastoidectomy or öpen cavity tympanoplasty.Patients and Methods: We retrospectively evaluated 190 operations of 182 patients 97 males, 85 females; mean age 30.6 years; range 9-70 years who undervvent radical mastoidectomy n=89 or öpen cavity tympanoplasty n=101 . Follow-up examinations included otomicroscopy.Patients with documented dural bone defects on examina- tion or operation records were further evaluated by axial and coronal computed tomography seans of the temporal bone. Those with suspected encephalocele were studied by magnetic resonance imaging.Results: Dural bone defects were deteeted in 17 patients peri- operatively. Of these, 14 defects were associated with chronic otitis media. Three iatrogenic bone defects were induced dur- ing obliteration of lateral sinüs thrombosis. The mastoid teğmen was the most common site of defects 41% and the most common etiologic factor was cholesteatoma 84% .Encephalocele was deteeted in one patient in whom radical mastoidectomy with lateral sinüs obliteration was performed due to lateral sinüs thrombophlebitis. Encephalomalasia was found nearby the defect area in two patients.Conclusion: Dural bone defects associated with chronic oti tis media are not rare, the most common cause being cholesteatoma. Repair of dural lacerations requires watertight elosure to prevent the occurrence of encephalocele.
Keywords:
Brain abscess/etiology cerebrospinal fluid otorrhea/etiology, cholesteatoma/diagnosis/radiography, duramater, ear, middle/ surgery, encephalocele/diagnosis/etiology, magnetic resonance imaging, mastoid/surgery, otitis media/surgery/complications, temporal bone/ abnormalities/surgery/radiography, tomography, X-ray computed,
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- Dedo GG, Sooy FA. Endaural encephalocele and cere- b rospinal fluid otorrhea. Ann Otol Rhinol Laryngol 1970; 7 9 : 1 6 8 - 7 7 .
- Kamerer DB, Caparosa RJ. Temporal bone encephalo- cele-diagnosis and treatment. Laryngoscope 1982;92(8 Pt 1):878-82.
- Jackson CG, Pappas DG Jr, Manolidis S, Glasscock ME 3rd, Von Doersten PG, Hampf CR, et al. Brain hernia- tion into the middle ear and mastoid: concepts in diag- nosis and surgical management. Am J Otol 1997;18: 198-205.
- Montgomery WW. Dural defects of the temporal bone. Am J Otol 1993;14:548-51.
- Mulcahy MM, McMenomey SO, Talbot JM, Delashaw JB Jr. Congenital encephalocele of the medial skull base. Laryngoscope 1997;107:910-4.
- Kaseff LG, Seidenwurm DJ, Nieberding PH, Nissen AJ, Remley KR, Dillon W. Magnetic resonance imaging of brain herniation into the middle ear. Am J Otol 1992; 13:74-7.
- Ferguson BJ, Wilkins RH, Hudson W, Farmer J Jr. Spontaneous CSF otorrhea from tegmen and posterior fossa defects. Laryngoscope 1986;96:635-44.
- Aristegui M, Falcioni M, Saleh E, Taibah A, Russo A, Landolfi M, et al. Meningoencephalic herniation into the middle ear: a report of 27 cases. Laryngoscope 1995; 105(5 Pt 1):512-8.
- de Carpentier J, Axon PR, Hargreaves SP, Gillespie JE, Ramsden RT. Imaging of temporal bone brain hernias: atypical appearances on magnetic resonance imaging. Clin Otolaryngol 1999;24:328-34.
- Glasscock ME 3rd, Dickins JR, Jackson CG, Wiet RJ, Feenstra L. Surgical management of brain tissue herni- ation into the middle ear and mastoid. Laryngoscope 1979;89:1743-54.
- Ramsden RT, Latif A, Lye RH, Dutton JE. Endaural cerebral hernia. J Laryngol Otol 1985;99:643-51.
- Akyıldız N. Kulak hastalıkları ve mikrocerrahisi. Cilt I. Ankara: Bilimsel Tıp Yayınevi; 1998.
- Levy RA, Platt N, Aftalion B. Encephalocele of the middle ear. Laryngoscope 1971;81:126-30.
- Patel RB, Kwartler JA, Hodosh RM, Baredes S. Spontaneous cerebrospinal fluid leakage and middle ear encephalocele in seven patients. Ear Nose Throat J 2000;79:372-3, 376-8.
- Özturan O, Çokkeser Y, Kızılay A, Sönmez E. Lateral sinus thrombophlebitis. [Article in Turkish] Kulak Buru n Bogaz Ihtis Derg 1999; 6:238-41.
- Valtonen H, Geyer C, Tarlov E, Heilman C, Poe D. Tegmental defects and cerebrospinal fluid otorrhea. ORL J Otorhinolaryngol Relat Spec 2001;63:46-52.
- Ramanikanth TV, Smith MC, Ramamoorthy R, Ramalingam KK. Postauricular cerebellar encephalo- coele secondary to chronic suppurative otitis media and mastoid surgery. J Laryngol Otol 1990;104:982-5.
- Kale SU, Pfleiderer AG, Cradwick JC. Bilateral defects of the tegmen tympani associated with brain and dural prolapse in a patient with pulsatile tinnitus. J Laryngol Otol 2000;114:861-3.
- Lundy LB, Graham MD, Kartush JM, LaRouere MJ. Temporal bone encephalocele and cerebrospinal fluid leaks. Am J Otol 1996;17:461-9.
- Rosenbaum TJ, Laxer KD, Rafal RD, Smith WB. Temporal lobe encephaloceles: etiology of partial com- plex seizures? Neurology 1985;35:287-8.
- Vallicioni JM, Girard N, Caces F, Braccini F, Magnan J, Chays A. Idiopathic temporal encephalocele: report of two cases. Am J Otol 1999;20:390-3.
- ISSN: 2602-4837
- Yayın Aralığı: Yılda 4 Sayı
- Başlangıç: 1991
- Yayıncı: İstanbul Üniversitesi
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