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Deboeuf L, Kalamarides M, Sterkers O, Law-Ye B, Lahlou G, Bernardeschi D, Alciato L. Reducing cerebrospinal fluid leak in vestibular schwannoma surgery via a retrosigmoid approach: a retrospective clinical study. Acta Neurochir (Wien) 2025; 167:119. [PMID: 40268800 PMCID: PMC12018616 DOI: 10.1007/s00701-025-06519-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Accepted: 04/04/2025] [Indexed: 04/25/2025]
Abstract
OBJECTIVE Cerebrospinal fluid leak can occur after retrosigmoid craniectomy and lead to substantial patient morbidity. The aim of this study was to compare two closure techniques for vestibular schwannoma resection in terms of cerebrospinal fluid leak and other procedure-related issues. METHODS This retrospective monocentric study included patients who underwent surgery for vestibular schwannoma resection via a retrosigmoid approach by the same oto-neurosurgical team. Before 2019, the retrosigmoid approach consisted of a craniectomy and the closure involved autologous abdominal fat graft obliteration (previous procedure). After 2019, the authors performed a craniotomy and used S53P4 bioactive glass granules to close the craniotomy site (new procedure). RESULTS We included 193 patients, 79 with the previous procedure and 114 the new procedure. Cerebrospinal fluid leak developed postoperatively in 3 patients with the new procedure and 14 with the previous procedure (p < 0.01). Need for surgical revision to treat the leak was lower with the new than previous procedure (1 vs 6 patients, p = 0.02) and the median length of hospital stay was reduced by 2 days with the new procedure (< 0.001). CONCLUSION The craniotomy/bioactive glass obliteration technique was associated with less cerebrospinal fluid leak as compared with craniectomy/autologous fat graft obliteration, less revision surgery and a shorter hospital stay.
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Affiliation(s)
- Louise Deboeuf
- Department of Neurosurgery, AP-HP, Pitié-Salpêtrière Hospital, 50/52 Bd Vincent Auriol, 75013, Paris, France
| | - Michel Kalamarides
- Department of Neurosurgery, AP-HP, Pitié-Salpêtrière Hospital, 50/52 Bd Vincent Auriol, 75013, Paris, France.
- Sorbonne Université, UPMC University, Paris 6, 75005, Paris, France.
- Schwannomatosis National Reference Center, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France.
| | - Olivier Sterkers
- Sorbonne Université, UPMC University, Paris 6, 75005, Paris, France
- Department of Otology, Auditory Implants and Skull Base Surgery, AP-HP, Pitié-Salpêtrière Hospital, 50/52 Bd Vincent Auriol, 75013, Paris, France
| | - Bruno Law-Ye
- Department of Neuroradiology, AP-HP, Pitié-Salpêtrière Hospital, 50/52 Bd Vincent Auriol, 75013, Paris, France
| | - Ghizlène Lahlou
- Sorbonne Université, UPMC University, Paris 6, 75005, Paris, France
- Department of Otology, Auditory Implants and Skull Base Surgery, AP-HP, Pitié-Salpêtrière Hospital, 50/52 Bd Vincent Auriol, 75013, Paris, France
| | - Daniele Bernardeschi
- Schwannomatosis National Reference Center, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
- Department of Otology, Auditory Implants and Skull Base Surgery, AP-HP, Pitié-Salpêtrière Hospital, 50/52 Bd Vincent Auriol, 75013, Paris, France
| | - Lauranne Alciato
- Sorbonne Université, UPMC University, Paris 6, 75005, Paris, France
- Department of Otology, Auditory Implants and Skull Base Surgery, AP-HP, Pitié-Salpêtrière Hospital, 50/52 Bd Vincent Auriol, 75013, Paris, France
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Handzel O, Ungar OJ. An algorithm for the surgical approach to spontaneous temporal bone CSF leak. Am J Otolaryngol 2024; 45:104411. [PMID: 39059170 DOI: 10.1016/j.amjoto.2024.104411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024]
Abstract
OBJECTIVE To suggest a comprehensive algorithm for the surgical approach for correcting of sources of temporal bone CSF leaks. METHODS A case series for patients operated in a single academic tertiary referral center between 2011 and 4.2022. Included in the study were 46 patients, 5 of whom had a bilateral problem, resulting in 51 pathologic temporal bones. The presentation was an active CSF leak (38 patients) or bacterial otogenic meningitis (8 patients). Follow up ranged from 8 months to 5 years. RESULTS Of the 42 ears operated via the default middle fossa approach, 37 were successful (88 %) in controlling CSF leak. None had intracranial complications or sensorineural hearing loss. Location, number and size of the defects, hearing status, associated superior semicircular canal dehiscence, additional intra-temporal or intra-cranial pathologies may indicate a transmastoid approach. Of the six ears that had a canal wall up mastoidectomy as a primary procedure, one required revision due to ongoing CSF leak. Five revision cases and three primary cases were effectively sealed with a subtotal petrosectomy and obliteration. One was lost to follow-up. Hearing was reconstructed with bone-anchored hearing implants in 6 out of these 8 ears. CONCLUSIONS The middle fossa approach could be used as a default approach for sealing TD. There are a number of indications for transmastoid approaches in both primary and revision cases. Obliteration of the ear was used in all revision cases. The suggested algorithm can help in planning surgery for temporal bone CSF leaks or a history of otogenic meningitis.
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Affiliation(s)
- Ophir Handzel
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Omer J Ungar
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Sahli-Vivicorsi S, Alavi Z, Bran W, Cadieu R, Meriot P, Leclere JC, Marianowski R. Mid-term outcomes of mastoid obliteration with biological hydroxyapatite versus bioglass: a radiological and clinical study. Eur Arch Otorhinolaryngol 2022; 279:4379-4388. [PMID: 35038026 DOI: 10.1007/s00405-022-07262-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 01/05/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE Radiological assessment of osseointegration of mastoid grafts: biological hydroxyapatite (Bio-Oss®) (BHA) versus bioglass S53P4 (Bonalive®) (BG). METHODS Retrospective (10 ± 4 months post-surgery) monocentric high resolution computed tomography (CT) scan assessment (November 2018 and October 2020) by two independent radiologists (R1, R2), blinded to patient allocation. All patients who had undergone a total mastoid obliteration were eligible. Excluded: complications namely otological acute or chronic infections, unbalanced metabolic disease, long-term cortico-steroid therapy, auto-immune disease, history of allergy to grafting materials and post-surgery CT scan in other centers (n = 8). PRIMARY OUTCOMES the ratio between two regions of interests (ROI) (graft to otic capsule). SECONDARY OUTCOMES resorption of mastoid grafts and assessment of clinical tolerance. RESULTS Included 21 patients (mean age: 29 ± 21 years; 5 females, 16 males). Significantly higher osseointegration for BHA vs. BG (R1 p = 0.043; R2 p = 0.004); almost perfect inter-reader agreement k = 0.922). The ROI ratios for BHA and BG to that of the otic capsule were 0.57 ± 0.11 (R1) and 0.59 ± 0.14 (R2); 0.43 ± 0.11 (R1) and 0.43 ± 0.08 (R2), respectively. Density increased significantly by 399 ± 261 Hounsfield units (HU) (p = 0.008) and decreased by 464 ± 161 HU (p < 0.001) for BHA vs. BG. Resorption rates were 24.1 ± 21.0% and 66.7 ± 15.1% (p = 0.076), respectively. No significant difference in clinical tolerance was observed. CONCLUSION Post-operative CT scan of mastoid obliteration seems reliable in assessment of biomaterial graft's mid-term feasibility and stability: BHA seems to provide a more optimal osseointegration versus BG with no significant differences in graft resorption and clinical tolerance.
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Affiliation(s)
- Sonia Sahli-Vivicorsi
- Department of Otorhinolaryngology and Head and Neck Surgery, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France.
| | - Zarrin Alavi
- Inserm, CIC 1412, Brest University Hospital, Brest, France
| | - William Bran
- Department of Radiology, Brest University Hospital, Brest, France
| | - Romain Cadieu
- Department of Radiology, Brest University Hospital, Brest, France
| | - Philippe Meriot
- Department of Radiology, Brest University Hospital, Brest, France
| | - Jean-Christophe Leclere
- Department of Otorhinolaryngology and Head and Neck Surgery, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France
| | - Rémi Marianowski
- Department of Otorhinolaryngology and Head and Neck Surgery, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France
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Skarzynski PH, Krol B, Skarzynski H, Cywka KB. Implantation of two generations of Bonebridge after mastoid obliteration with bioactive glass S53P4. Am J Otolaryngol 2022; 43:103601. [PMID: 35981433 DOI: 10.1016/j.amjoto.2022.103601] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE After radical surgery for chronic cholesteatoma (CWD mastoidectomy), patients have the option to have the posterior wall of their external auditory canal surgically reconstructed with S53P4 bioactive glass. The procedure eliminates some of the restrictions related to having a postoperative cavity and extends the options for a hearing prosthesis. If classic reconstruction is not possible and a hearing aid is not used, we suggest use of a Bonebridge implant. METHODS This study describes, over 18 months of follow-up, 16 patients after a two-stage surgical procedure: obliteration of the mastoid cavity with bioactive glass followed by Bonebridge implantation. There were 7 patients who received the first generation implant (BCI 601) and 9 who used the second (BCI 602). Before and after implantation, pure tone audiometry, sound field thresholds, and free-field audiometry were performed. Speech reception thresholds in noise were assessed using the Polish Sentence Matrix Test. Subjective assessment of benefits was done using the APHAB (Abbreviated Profile of Hearing Aid Benefit) questionnaire. RESULTS During the observation period, no serious complications were found. The study demonstrated the safety and validity of the procedures and confirmed the safety of using S53P4 bioactive glass in otosurgery (antibacterial effect, nonrecurrence of cholesteatoma, and no effect on the inner ear). The audiological benefits expected from using the Bonebridge implant processor were also confirmed. CONCLUSION It is concluded that, after reconstructing the posterior wall of the external auditory canal with bioactive glass, two-stage implantation of a Bonebridge implant in a typical site is a safe solution for patients who have difficult anatomical conditions following their CWD mastoidectomy.
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Affiliation(s)
- Piotr H Skarzynski
- Teleaudiology and Screening Department, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw, Kajetany, Poland; Heart Failure and Cardiac Rehabilitation Department, Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland; Institute of Sensory Organs, Kajetany, Warsaw, Poland.
| | - Bartlomiej Krol
- Otorhinolaryngosurgery Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw, Kajetany, Poland
| | - Henryk Skarzynski
- Otorhinolaryngosurgery Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw, Kajetany, Poland
| | - Katarzyna B Cywka
- Otorhinolaryngosurgery Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw, Kajetany, Poland
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Swanson J, Oetojo W, Uram Z, Jusue-Torres I, Zakaria J, Kircher ML, Germanwala AV. Treatment of tegmen dehiscence using a middle fossa approach and autologous temporalis fascia graft: Outcomes from a single center. Clin Neurol Neurosurg 2022; 219:107331. [PMID: 35724613 PMCID: PMC10171465 DOI: 10.1016/j.clineuro.2022.107331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/03/2022] [Accepted: 06/04/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Although bony defects of the tegmen surface are relatively common, the majority of dehiscences are asymptomatic. For those who experience symptoms, there is a wide spectrum of relatively benign manifestations such as hearing loss and otorrhea to potentially more serious but rare sequelae such as epilepsy and meningitis. Surgical management of tegmen dehiscences (TDs) can help prevent these symptoms. In this manuscript, we present one of the largest reported single team experiences of using a temporal craniotomy with middle cranial fossa approach and temporalis fascia graft in the treatment of tegmen defects. METHODS We retrospectively reviewed every case of a TD surgically repaired by the same neurosurgeon/otolaryngologist team at Loyola University Medical Center from May 2015 to January 2022. In our chart review, we identified 44 patients with 48 cases of tegmen defect repair. We analyzed patient characteristics, operative details, and postoperative outcomes. RESULTS 44 patients met inclusion criteria for the presence of TD (mean age 55 years, 55% male, and average body mass index 35.6). 89% of these patients had no clear etiology for the dehiscence. Commonly reported symptoms were hearing loss (89%) and CSF otorrhea (82%). The least reported presenting signs and symptoms were seizures (5%) and meningitis (2%). Most defects were repaired with both temporalis fascial and calvarial bone grafts (63%), while a minority were treated with temporalis fascia only (33%), temporalis fascia with muscle (2%), or fascia lata (2%). Every patient in our sample experienced resolution of CSF otorrhea after tegmen repair and 81% of the sample reported subjective hearing improvements after surgery. 6% of our sample had post-operative infections and 8% of patients underwent repeat unilateral surgery for a surgical complication. CONCLUSION Craniotomy for middle fossa approach using autologous temporalis fascial grafts is a safe and effective method for the treatment of TD. These procedures should be performed by experienced and multidisciplinary teams.
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Affiliation(s)
- James Swanson
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - William Oetojo
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Zachary Uram
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Ignacio Jusue-Torres
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Jehad Zakaria
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Matthew L Kircher
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA; Department of Otolaryngology, Loyola University Medical Center, Maywood, IL, USA
| | - Anand V Germanwala
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA; Department of Neurological Surgery, Loyola University Medical Center, Maywood, IL, USA; Department of Otolaryngology, Loyola University Medical Center, Maywood, IL, USA.
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Cherdantseva DD, Vakhrushev SG, Toropova LA. [Mastoid obliteration during last 5 years]. Vestn Otorinolaringol 2022; 87:55-60. [PMID: 36580510 DOI: 10.17116/otorino20228706155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The article presents modern approaches to mastoid obliteration in cases of chronic purulent otitis media with cholesteatoma, published in peer-reviewed russian and foreign journals from 2017 to 2021. The review tells us about effect of mastoid cavity obliteration on reducing the recurrence of cholesteatoma, improving the quality of life of patients according to the results of international questionnaires and the effect of surgery on hearing in the long-term postoperative period. An analysis of the use of autologous and biocompatible materials in middle ear surgery is presented. Their safety and ease of use during surgical intervention were evaluated.
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Affiliation(s)
- D D Cherdantseva
- Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - S G Vakhrushev
- Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - L A Toropova
- Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
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