Document Detail

Does packing the eustachian tube impact cerebrospinal fluid rhinorrhea rates in translabyrinthine vestibular schwannoma resections?
MedLine Citation:
PMID:  17704723     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To calculate cerebrospinal fluid (CSF) leak rates for translabyrinthine (TL), middle cranial fossa (MCF), and retrosigmoid/suboccipital (SO) craniotomies performed for removal of vestibular schwannoma (VS) and analyze whether packing the eustachian tube (ET) in TL VS resections impacts CSF rhinorrhea rates. STUDY DESIGN: Retrospective. SETTING: Tertiary care center. METHODS: Chart review. RESULTS: Three hundred fifty-nine VS resections were reviewed in 356 patients ranging from 10 to 86 years of age. Two hundred thirty-one TL, 70 MCF, 53 SO, and 5 combined TL/SO procedures were analyzed. Total CSF leak rates (incisional, otorrhea, and rhinorrhea) were 14.2% for TL, 11.4% for MCF, and 13.2% for SO approaches. Differences in overall CSF leak rates were not statistically significant. For those who underwent TL craniotomies, 2 groups of patients were identified based on whether their ETs were packed during surgery. In 1 group, the incus was removed, the aditus enlarged, the ET packed, and the middle ear filled with muscle. In the second group, the aditus, epitympanum and middle ear were packed without removing the incus, and the ET was not packed. Of 148 patients who had their ET packed, 12 developed CSF rhinorrhea (8.1%). The CSF rhinorrhea rate for patients who did not have ET packing was 5.9% (3 of 51 patients). This difference was not statistically significant (p = 0.80). When Proplast was used to pack the ET (121 patients), the CSF rhinorrhea rate was 5.8%. Unfortunately, this material extruded in 4 of 121 patients (3.3%) and presented clinically as delayed purulent otorrhea. CONCLUSION: Cerebrospinal fluid leak rates were similar in patients undergoing TL, SO, and MCF approaches, and CSF rhinorrhea was not decreased by ET packing. Patients whose ETs are packed with Proplast are at risk for extrusion and otorrhea years after their initial VS resection.
Abraham Jacob; Jared S Bortman; Lawrence L Robinson; Lianbo Yu; Edward E Dodson; D Bradley Welling
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology     Volume:  28     ISSN:  1531-7129     ISO Abbreviation:  Otol. Neurotol.     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-10-23     Completed Date:  2007-11-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100961504     Medline TA:  Otol Neurotol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  934-8     Citation Subset:  IM    
Department of Otolaryngology-Head & Neck Surgery, The Ohio State University, Columbus, Ohio 43210, USA.
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MeSH Terms
Aged, 80 and over
Cerebrospinal Fluid Rhinorrhea / epidemiology,  etiology*
Cohort Studies
Cranial Nerve Neoplasms / complications*,  surgery*
Eustachian Tube*
Middle Aged
Neuroma, Acoustic / complications*,  surgery*
Otologic Surgical Procedures*
Postoperative Complications / epidemiology,  etiology*
Retrospective Studies
Vestibulocochlear Nerve Diseases / complications*,  surgery*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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