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Management of brain herniation and cerebrospinal fluid leak in revision chronic ear surgery.

Publication ,  Journal Article
Wootten, CT; Kaylie, DM; Warren, FM; Jackson, CG
Published in: Laryngoscope
July 2005

OBJECTIVES/HYPOTHESIS: Brain herniation and cerebrospinal fluid (CSF) leakage into the middle ear and mastoid are rare but described complications of chronic ear disease. This paper will discuss the presentation and management of brain herniation and/or CSF leak encountered in revision chronic ear surgery. STUDY DESIGN: Retrospective chart review. METHODS: Twelve of 1,130 cases of revision chronic ear surgery in which brain herniation or CSF leak was diagnosed were identified and analyzed. RESULTS: Ten (83%) patients' initial diagnosis was tympanic membrane (TM) perforation with cholesteatoma and two (17%) with TM perforation without cholesteatoma. Initial revision procedures included one (8.3%) tympanoplasty with canal-wall-up mastoidectomy maintaining ossicular continuity, two (17%) tympanoplasties with canal-wall-down (CWD) mastoidectomies with ossicular chain reconstruction (OCR), and nine (75%) tympanoplasties with CWD mastoidectomies without OCR. Three (25%) required a second procedure, two (17%) a third, and one (8.3%) a fourth, finally resulting in four (33%) with an ossicular reconstruction and eight (67%) without. Brain herniation and/or CSF leak were repaired by way of transmastoid and middle fossa approaches. Preoperative and postoperative pure-tone average air-bone gaps were statistically similar (33.1 and 28.1 dbHL, respectively; P = .464). CONCLUSIONS: Brain herniation and/or CSF leak appear to be rare complications of surgery for revision chronic ear disease. Their management require adherence to the principles of establishing a safe ear with hearing restoration as a secondary goal.

Duke Scholars

Published In

Laryngoscope

DOI

ISSN

0023-852X

Publication Date

July 2005

Volume

115

Issue

7

Start / End Page

1256 / 1261

Location

United States

Related Subject Headings

  • Tympanoplasty
  • Retrospective Studies
  • Reoperation
  • Postoperative Complications
  • Otorhinolaryngology
  • Otitis Media with Effusion
  • Ossicular Replacement
  • Middle Aged
  • Male
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
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Wootten, C. T., Kaylie, D. M., Warren, F. M., & Jackson, C. G. (2005). Management of brain herniation and cerebrospinal fluid leak in revision chronic ear surgery. Laryngoscope, 115(7), 1256–1261. https://doi.org/10.1097/01.MLG.0000165455.20118.E3
Wootten, Christopher T., David M. Kaylie, Frank M. Warren, and C Gary Jackson. “Management of brain herniation and cerebrospinal fluid leak in revision chronic ear surgery.Laryngoscope 115, no. 7 (July 2005): 1256–61. https://doi.org/10.1097/01.MLG.0000165455.20118.E3.
Wootten CT, Kaylie DM, Warren FM, Jackson CG. Management of brain herniation and cerebrospinal fluid leak in revision chronic ear surgery. Laryngoscope. 2005 Jul;115(7):1256–61.
Wootten, Christopher T., et al. “Management of brain herniation and cerebrospinal fluid leak in revision chronic ear surgery.Laryngoscope, vol. 115, no. 7, July 2005, pp. 1256–61. Pubmed, doi:10.1097/01.MLG.0000165455.20118.E3.
Wootten CT, Kaylie DM, Warren FM, Jackson CG. Management of brain herniation and cerebrospinal fluid leak in revision chronic ear surgery. Laryngoscope. 2005 Jul;115(7):1256–1261.
Journal cover image

Published In

Laryngoscope

DOI

ISSN

0023-852X

Publication Date

July 2005

Volume

115

Issue

7

Start / End Page

1256 / 1261

Location

United States

Related Subject Headings

  • Tympanoplasty
  • Retrospective Studies
  • Reoperation
  • Postoperative Complications
  • Otorhinolaryngology
  • Otitis Media with Effusion
  • Ossicular Replacement
  • Middle Aged
  • Male
  • Humans