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Tegmen tympani defect and brain herniation secondary to mastoid surgery: case presentation.

Egilmez OK, Hanege FM, Kalcioglu MT, Kaner T, Kokten N - Case Rep Otolaryngol (2014)

Bottom Line: Brain herniation into the middle ear is very rarely seen.In addition to reasons like congenital factors, trauma, and infection, tegmen defect may develop as a result of iatrogenic events secondary to chronic otitis media surgery with or without cholesteatoma.Since it may cause life-threatening complications, patients must be evaluated and monitored for tegmen defect.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology, Goztepe Training and Research Hospital, School of Medicine, Istanbul Medeniyet University, 34722 Istanbul, Turkey.

ABSTRACT
Brain herniation into the middle ear is very rarely seen. In addition to reasons like congenital factors, trauma, and infection, tegmen defect may develop as a result of iatrogenic events secondary to chronic otitis media surgery with or without cholesteatoma. Since it may cause life-threatening complications, patients must be evaluated and monitored for tegmen defect. In this paper, diagnosis and treatment of a brain herniation case due to iatrogenic tegmen defect were described along with relevant literature.

No MeSH data available.


Related in: MedlinePlus

Herniated fibrotic glial tissue is excised by neurosurgery team.
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fig3: Herniated fibrotic glial tissue is excised by neurosurgery team.

Mentions: Admitted to our clinic with complaints of right ear discharge from childhood, hearing impairment, occasional attacks of dizziness, and pain in face and ear; a 33-year-old woman who underwent radical mastoidectomy for chronic otitis media with cholesteatoma at an external facility on May 2012. A growing mass was observed about 2 months postoperatively at the entrance of the right external auditory canal. Patient had no complaints such as ear discharge, dizziness, or epilepsy. Patient applied to our clinic at about 10 months postoperatively. Her medical examination showed a soft mass-like lesion with a diameter of about 1.5 cm at the posterosuperior wall of the right external auditory canal entrance (Figure 1). Temporal bone computed tomography and cranial contrast MRI were performed. CT showed a 13 mm defect at tegmen of right temporal bone. MRI showed a 12 mm defect at lateral segment of right tegmen tympani and a nodular signal of about 15 × 13 × 10 mm, which was isointense to brain parenchyma in all sequences filling the right middle ear and proximal segment lodge of the external ear canal (Figure 2). The mass was determined to be dural prolapsus and focal herniation of brain parenchyma. Neurosurgery clinic was consulted and surgery was scheduled. The operation was accompanied by neurosurgeons. After ensuring the operation site through transmastoid approach under general anaesthesia, patient was referred to neurosurgery team. Neurosurgery team excised the herniated fibrotic glial tissue (Figure 3) extending to external ear canal by using bipolar cautery. Duraplasty with galea was performed after determining bone borders. A barrier was created with fibrin glue (Tisseel Kit). Because of the absence of perioperative CSF, case was referred to otorhinolaryngology team once more. Grafts were taken from conchal cartilage and temporalis muscle fascia. Cavity was obliterated with cartilage grafts (Figure 4). A flat plane was created by laying the temporalis muscle fascia graft on cartilage grafts. Durability was improved with fibrin glue (Tisseel Kit) (Figure 5), and thus the operation was completed. There were no complications such as postoperative otorrhoea, meningitis, or epilepsy. Patient had no complaints in followups at week 1 and months 1, 3, 6, and 15 postoperatively and no pathology was observed at the herniated segment through the defective area.


Tegmen tympani defect and brain herniation secondary to mastoid surgery: case presentation.

Egilmez OK, Hanege FM, Kalcioglu MT, Kaner T, Kokten N - Case Rep Otolaryngol (2014)

Herniated fibrotic glial tissue is excised by neurosurgery team.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4129166&req=5

fig3: Herniated fibrotic glial tissue is excised by neurosurgery team.
Mentions: Admitted to our clinic with complaints of right ear discharge from childhood, hearing impairment, occasional attacks of dizziness, and pain in face and ear; a 33-year-old woman who underwent radical mastoidectomy for chronic otitis media with cholesteatoma at an external facility on May 2012. A growing mass was observed about 2 months postoperatively at the entrance of the right external auditory canal. Patient had no complaints such as ear discharge, dizziness, or epilepsy. Patient applied to our clinic at about 10 months postoperatively. Her medical examination showed a soft mass-like lesion with a diameter of about 1.5 cm at the posterosuperior wall of the right external auditory canal entrance (Figure 1). Temporal bone computed tomography and cranial contrast MRI were performed. CT showed a 13 mm defect at tegmen of right temporal bone. MRI showed a 12 mm defect at lateral segment of right tegmen tympani and a nodular signal of about 15 × 13 × 10 mm, which was isointense to brain parenchyma in all sequences filling the right middle ear and proximal segment lodge of the external ear canal (Figure 2). The mass was determined to be dural prolapsus and focal herniation of brain parenchyma. Neurosurgery clinic was consulted and surgery was scheduled. The operation was accompanied by neurosurgeons. After ensuring the operation site through transmastoid approach under general anaesthesia, patient was referred to neurosurgery team. Neurosurgery team excised the herniated fibrotic glial tissue (Figure 3) extending to external ear canal by using bipolar cautery. Duraplasty with galea was performed after determining bone borders. A barrier was created with fibrin glue (Tisseel Kit). Because of the absence of perioperative CSF, case was referred to otorhinolaryngology team once more. Grafts were taken from conchal cartilage and temporalis muscle fascia. Cavity was obliterated with cartilage grafts (Figure 4). A flat plane was created by laying the temporalis muscle fascia graft on cartilage grafts. Durability was improved with fibrin glue (Tisseel Kit) (Figure 5), and thus the operation was completed. There were no complications such as postoperative otorrhoea, meningitis, or epilepsy. Patient had no complaints in followups at week 1 and months 1, 3, 6, and 15 postoperatively and no pathology was observed at the herniated segment through the defective area.

Bottom Line: Brain herniation into the middle ear is very rarely seen.In addition to reasons like congenital factors, trauma, and infection, tegmen defect may develop as a result of iatrogenic events secondary to chronic otitis media surgery with or without cholesteatoma.Since it may cause life-threatening complications, patients must be evaluated and monitored for tegmen defect.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology, Goztepe Training and Research Hospital, School of Medicine, Istanbul Medeniyet University, 34722 Istanbul, Turkey.

ABSTRACT
Brain herniation into the middle ear is very rarely seen. In addition to reasons like congenital factors, trauma, and infection, tegmen defect may develop as a result of iatrogenic events secondary to chronic otitis media surgery with or without cholesteatoma. Since it may cause life-threatening complications, patients must be evaluated and monitored for tegmen defect. In this paper, diagnosis and treatment of a brain herniation case due to iatrogenic tegmen defect were described along with relevant literature.

No MeSH data available.


Related in: MedlinePlus