Cerebrospinal Fluid Otorrhea ; surgery ; Craniotomy ; Encephalocele ; Humans ; Mastoid ; surgery

Cerebrospinal Fluid Otorrhea/surgery* ; Child ; Humans ; Temporal Bone

OBJECTIVE: To improve the possibility of diagnosis of the Mondini dysplasia. METHOD: The clinical manifestation and the examination of CT and MRI and surgical treatment of the Mondini dysplasia were discussed. RESULT: Because Mondini dysplasia with cerebrospinal fluid leak would occur recurrent meningitis, the patients were often difficult to be diagnosed. Especially. if the defect was unilateral, it was frequently unrecognized. CONCLUSION The patients with recurrently unclear cerebrospinal fluid leak and meningitis would be suspected. The diagnosis of the disease is based on the examination of the temporal bone CT and MRI. To the patients with cerebrospinal fluid leak, a transtympanic closure is one of very effective management.
Adolescent ; Cerebrospinal Fluid Otorrhea ; diagnosis ; etiology ; surgery ; Ear, Inner ; abnormalities ; Humans ; Male ; Tympanoplasty ; methods

Objective: To explore the imaging evaluation of cerebrospinal fluid (CSF) otorrhea associated with inner ear malformation (IEM) in children. Methods: The clinical data of 28 children with CSF otorrhea associated with IEM confirmed by surgical exploration in Beijing Children's Hospital, from Nov, 2016 to Jan, 2021, were analyzed retrospectively,including 16 boys and 12 girls, aged from 8-month to 15-year and 8-month old, with a median age of 4-year old. The shapes of stapes were observed during the exploration surgery, and the imaging features of temporal bone high resolution CT(HRCT) and inner ear MRI pre- and post-operation were analyzed. Results: In 28 children with CSF otorrhea, 89.3%(25/28) had stapes footplates defect during exploration. Preoperative CT showed indirect signs such as IEM, tympanic membrane bulging, soft tissue in the tympanum and mastoid cavity. IEM included four kinds: incomplete partition type I (IP-Ⅰ), common cavity (CC), incomplete partition type Ⅱ (IP-Ⅱ), and cochlear aplasia (CA); 100%(28/28) presented with vestibule dilation; 85.7%(24/28) with a defect in the lamina cribrosa of the internal auditory canal. The direct diagnostic sign of CSF otorrrhea could be seen in 73.9%(17/23) pre-operative MRI: two T2-weighted hyperintense signals between vestibule and middle ear cavity were connected by slightly lower or mixed intense T2-weighted signals, and obvious in the coronal-plane; 100%(23/23) hyperintense T2-weighted signals in the tympanum connected with those in the Eustachian tube.In post-operative CT, the soft tissues in the tympanum and mastoid cavity decreased or disappeared as early as one week. In post-operative MRI, the hyperintense T2-weighted signals of tympanum and mastoid decreased or disappeared in 3 days to 1 month,soft tissues tamponade with moderate intense T2-weighted signal were seen in the vestibule in 1-4 months. Conclusions: IP-Ⅰ, CC, IP-Ⅱ and CA with dilated vestibule can lead to CSF otorrhea. Combined with special medical history, T2-weighted signal of inner ear MRI can provide diagnostic basie for most children with IEM and CSF otorrhea.HRCT and MRI of inner ear can also be used to evaluate the effect of surgery.
Male ; Female ; Child ; Humans ; Aged ; Infant ; Child, Preschool ; Cerebrospinal Fluid Otorrhea/surgery* ; Retrospective Studies ; Vestibule, Labyrinth ; Temporal Bone ; Ear, Middle

OBJECTIVETo describe and analyze the surgical outcomes of modified enlarged translabyrinthine approach(ETLA), which is combined with middle ear eradication and blind sac technique.

METHODSA retrospective study was conducted on 28 patients who underwent surgery for vestibular schwannoma (VS) via modified ETLA from Jan. 2001 to Dec. 2012. The sizes of tumors were 25-52 mm[(38.2 ± 9.1) mm (X(-) ± s)]. Main outcomes measures included the rate of total removal, the rate of cerebral spinal fluid (CSF) leakage after surgery, complications, and intraoperative anatomical preservation of facial nerve and facial nerve function.

RESULTSAmong the 28 patients who underwent modified ETLA, the rate of total removal was 100%. There was no death after surgery via modified ETLA. The rate of CSF leakage after surgery was 3.5% (1/28). The rate of intraoperative anatomical preservation of facial nerve was 89.3% (25/28).Short-term and long-term good facial nerve function rates were 25.0% (7/28) and 42.9% (12/28), respectively.

CONCLUSIONSModified ETLA is suitable for VS>3 cm with extension to the anterior region of cerebellopontine angle, VS involve with labyrinth part of facial nerve, high jugular bulb, proposing sigmoid sinus and highly pneumatized temporal bone. This approach can provide a wide surgical field and well prevention of CSF leakage.

Adolescent ; Adult ; Cerebrospinal Fluid Otorrhea ; prevention & control ; Ear, Inner ; surgery ; Female ; Humans ; Male ; Middle Aged ; Neuroma, Acoustic ; surgery ; Otologic Surgical Procedures ; methods ; Retrospective Studies ; Young Adult

OBJECTIVE: Microvascular decompression(MVD) for hemifacial spasm(HFS) is well established. However delayed postoperative facial palsy has not been substantially reported. The authors reviewed patients with HFS who underwent MVD in our institution to evaluate the post-operative courses with special attention to the development of delayed facial palsy. METHODS: Records of 144 cases(137 patients) from 1988 to 1997 were reviewed. Of these patients, 12(8.3%) developed delayed facial palsy. Follow-ups via chart and phone records were available for 10 of 12 patients. RESULTS: Reviews of these 12 cases demonstrated that 3 men, 9 women of with average age of 53(range 45-60) had delayed facial palsy. Among them, 2 had repeated operation. The preoperative duration of symptoms averaged 12 years(range 1-30) and 4 patients had mild preoperative weakness. All were improved their HFS within 7 days after MVD. Offending vessels were anterior inferior cerebellar artery(AICA) in 7. Five of these were meatal branches and 2 were sandwich type compressions. One case was combined compression of AICA and posterior inferior cerebellar artery. Three to 7 pieces of Teflon felt were necessary for the decompression of offender. The onset of weakness occurred invariably between postoperative day 6 and 11. Two cases had associated complications. The one was hearing loss and the other was meningitis accompanied by cerebrospinal fluid otorrhea. Ten cases received steroids following the onset of their facial palsies. Duration of follow up of 10 cases was 21months(3months-5years). Three cases showed complete recovery at 4, 8 and 12 weeks, respectively. Four patients have improved to House Grade II at 5 weeks and remaining three showed continuing improvement until last follow-up. CONCLUSIONS: Delayed facial palsy following MVD in HFS patients is not uncommon, being 8.3% in our series. It occurs consistently 1-2 weeks postoperatively. Possible causes include facial nerve exit zone injury with Teflon felt or delayed facial nerve edema. Spontaneous recovery usually occur within several weeks.
Arteries ; Cerebrospinal Fluid Otorrhea ; Criminals ; Decompression ; Edema ; Facial Nerve ; Facial Paralysis* ; Female ; Follow-Up Studies ; Hearing Loss ; Hemifacial Spasm* ; Humans ; Male ; Meningitis ; Microvascular Decompression Surgery* ; Polytetrafluoroethylene ; Steroids

OBJECTIVETo explore the common complications related to acoustic neuromas and to search methods for preventing from them.

METHODSOne hundred and five patients with acoustic neuromas underwent 110 operations with the retrosigmoid approach, middle cranial fossa approach and labyrinth approach. All cases were followed up more than 1 month after surgery.

RESULTSOf 110 cases, the most frequent complication was hearing disability which occurred in 95 cases (95/110, 86.4%). and the facial paralysis was in 63.6% (70/110) after one month. Other complications were cerebrospinal fluid fistulas (CSF, 12.7%, 14/110) , intracranial hematoma (5.5%, 6/110), cranial nerve palsies (4.5%, 5/110), meningitis (3.6%, 4/110), tetraparesis (3.6%, 4/110), balance disturbance (1.8%, 2/110), hemiparalysis and anepia (0.9%, 1/110). Effective stopping bleeding during operation and controlling blood pressure after operation, as well as keeping effective sedation in 24 hours after operation were the important ways to prevent from intracranial hematoma The haemorrhage often accrued in 48 hours post-operation. CSF in this series was another common complication in acoustic neuroma surgery. Ten cases with CSF subcutaneous retro-auricular had been successfully controlled by conservative treatment. Of 4 cases with rhinorrhea CSF, 3 of them were required surgical management, another one got self-cure by bed rest. The ventricular drainage pro-operation was the most important procedure for drawdown the hypsi-cranium pressure.

CONCLUSIONSThe key factors to avoid the complications include mastering the anatomy of different surgical approach, how much of the tumor size, surgical experience and preoperative evaluation of patients' imaging information and other clinical data.

Adolescent ; Adult ; Aged ; Cerebrospinal Fluid Otorrhea ; etiology ; prevention & control ; Cerebrospinal Fluid Rhinorrhea ; etiology ; prevention & control ; Facial Paralysis ; etiology ; prevention & control ; Female ; Humans ; Male ; Meningitis ; etiology ; prevention & control ; Middle Aged ; Neuroma, Acoustic ; surgery ; Postoperative Complications ; etiology ; prevention & control ; Young Adult