Management of iatrogenic tegmen plate defects: our clinical experience and surgical technique
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OTOLOGY
Management of iatrogenic tegmen plate defects: our clinical experience and surgical technique Hassan Wahba • Samer Ibrhaim • Tamer Ali Youssef
Received: 20 July 2012 / Accepted: 2 November 2012 / Published online: 21 November 2012 Ó Springer-Verlag Berlin Heidelberg 2012
Abstract The objective of our study is to present our recommended approach for surgical management of iatrogenic tegmen plate defects. Patients diagnosed to have symptomatic iatrogenic tegmen plate defects were treated by one of the authors using a one-stage trans-mastoid standardized surgical procedure at Ain Shams University Hospitals. Patients’ information records included history, complete examination, computed tomography (CT) and magnetic resonance imaging (MRI) of the temporal bone, and the followup data after the procedure to assess the final outcome in each case. Twelve patients with symptomatic iatrogenic tegmen plate defects were included in our study. The tegment plate defect size in the 12 patients varied from 2.2 to 15 mm (mean 5.6 ± 1.3). Postoperative followup of the patients ranged from 6 months up to 2 years (mean 1.6 ± 0.8). One patient only developed wound infection and was treated with antibiotics and regular dressings, with no other immediate postoperative complications (intracranial hematoma or meningitis). In the entire patient group, no local recurrence of middle fossa encephalocele was recorded. Our surgical trans-mastoid approach using multilayered autologous grafts is successful in closing iatrogenic tegmen plate defects more than 2.2 mm and less than 15 mm.
Introduction
This work was done in Ain Shams University Hospital.
The defects of the temporal bone and the resultant leak of cerebrospinal fluid may be secondary or primary (spontaneous). Secondary defects occur after temporal bone trauma, surgery (iatrogenic), neoplastic invasion of the skull base, severe inflammatory condition as cholesteatoma, and necrotizing inflammations of the temporal bone (diabetes mellitus) [1]. Temporal bone defects are frequently associated with encephalic herniation of the temporal lobe [2] (even through defects as small as 2 mm) [3] and occur predominately in the floor of the middle cranial fossa at the tegmen [2]. The clinical presentation of middle fossa encephalocele (MFE) is generally mild, with symptoms of serous otitis media; aural fullness, hearing loss, and cerebrospinal fluid (CSF) otorrhea, although life-threatening complications such as meningitis, brain abscess, and temporal lobe seizures are occasionally sentinel events. Because of the potential morbidity associated with MFE, rapid diagnosis and surgical management are of paramount importance [4]. No standard surgical protocol for repair of the tegmen plate defect (TPD) is available until now with different surgical approaches used including trans-mastoid approach, middle fossa craniotomy, or a combined approach. In addition, multiple materials have been used to repair the defects [5]. The aim of our study was to describe the clinical presentation, diagnostic proc
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