Dural bone defects and encephalocele associated with chronic otitis media or its surgery

Yıl 2002, Cilt: 9 Sayı: 6, 403 - 409, 20.12.2002

Ahmet Kızılay İbrahim Aladağ Yaşar Çokkeser Orhan Özturan

Öz

Objectives: We investigated the incidence of dural bone defects and encephalocele follovving radical mastoidectomy or öpen cavity tympanoplasty.Patients and Methods: We retrospectively evaluated 190 operations of 182 patients 97 males, 85 females; mean age 30.6 years; range 9-70 years who undervvent radical mastoidectomy n=89 or öpen cavity tympanoplasty n=101 . Follow-up examinations included otomicroscopy.Patients with documented dural bone defects on examina- tion or operation records were further evaluated by axial and coronal computed tomography seans of the temporal bone. Those with suspected encephalocele were studied by magnetic resonance imaging.Results: Dural bone defects were deteeted in 17 patients peri- operatively. Of these, 14 defects were associated with chronic otitis media. Three iatrogenic bone defects were induced dur- ing obliteration of lateral sinüs thrombosis. The mastoid teğmen was the most common site of defects 41% and the most common etiologic factor was cholesteatoma 84% .Encephalocele was deteeted in one patient in whom radical mastoidectomy with lateral sinüs obliteration was performed due to lateral sinüs thrombophlebitis. Encephalomalasia was found nearby the defect area in two patients.Conclusion: Dural bone defects associated with chronic oti­ tis media are not rare, the most common cause being cholesteatoma. Repair of dural lacerations requires watertight elosure to prevent the occurrence of encephalocele.

Anahtar Kelimeler

Brain abscess/etiology, cerebrospinal fluid otorrhea/etiology, cholesteatoma/diagnosis/radiography, duramater, ear, middle/ surgery, encephalocele/diagnosis/etiology, magnetic resonance imag­ing, mastoid/surgery, otitis media/surgery/complications, temporal bone/ abnormalities/surgery/radiography, tomography, X-ray computed

Kronik otit veya cerrahisi sonrasında oluşan dural kemik defektleri ve ensefalosel

Öz

Amaç: Radikal mastoidektomi veya açık kavite timpanoplasti yapılan olgularda dural kemik defekti ve ensefalosel sıklığı arafltırıldı.Hastalar ve Yöntemler: Çalıflmada 182 olguda yapılan 190 açık kavite n=101 veya radikal mastoidektomi n=89 ameliyatında dural kemik defekti ve ensefalosel geliflimi retrospektif olarak arafltırıldı. Kontrollerde olguların otomikroskobikmuayeneleri yapıldı. Ameliyat notunda veya muayenededural kemik defekti saptanan olgularda temporal kemiğinaksiyel ve koronal planda bilgisayarlı tomografi incelemesi yapıldı. Ensefaloselden flüphelenilen olgularda ek olarak manyetik rezonans görüntülemeye baflvuruldu.Bulgular: Ameliyat sırasında 17 olguda dural kemik defekti saptandı; 14 olguda defektin kronik otite bağlı olufltuğu belirlendi. Lateral sinüs tromboflebiti nedeniyle ameliyat edilen üç olguda posterior fossada kemik defekti iyatrojenik olarak oluflmufltu. Defekt, en sık mastoid tegmende %41 bulundu. En yüksek oranda %84 karflılaflılanetyolojik neden kolesteatom idi. Lateral sinüs tromboflebiti nedeniyle radikal mastoidektomi ve lateral sinüs obliterasyonu yapılan bir olguda ensefalosel saptandı. İki olguda defekte komflu alanda ensefalomalazi belirlendi.Sonuç: Kronik otit nedeniyle geliflen dural kemik defektiseyrek değildir ve en sık görülen neden kolesteatomdur.Ensefalosel geliflimini önlemek için dura laserasyonları sugeçirmez sıkılıkta tamir edilmelidir

Anahtar Kelimeler

Beyin apsesi/etyoloji, beyin-omurilik sıvısı otoresi/etyoloji, kolesteatom/tanı/radyografi, dura mater, kulak, orta/cerrahi, ensefalosel/tanı/etyoloji, manyetik rezonans görüntüleme, mastoid/cerrahi, otitis media/cerrahi/komplikasyon, temporal kemik/anormallik/cerrahi/radyografi, bilgisayarlı tomografi

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