Tegmental defects and cerebrospinal fluid otorrhea.
Congenital tegmental defects that present as unsuspected cerebrospinal fluid (CSF) otorrhea are diagnostic and therapeutic challenges. We reviewed 5 such patients to determine an optimal strategy for evaluation. Five patients presented with watery otorrhea, 4 of them after ventilation tube placement, and only 1 with rhinorrhea. The preoperative analysis of middle ear effusion for beta(2)-transferrin was positive in 2/4, equivocal in 1/4 and false negative in 1/4. Computerized tomography (CT) revealed nonspecific tegmental defects in all 5 patients. Magnetic resonance imaging (MRI) demonstrated meningoencephalocele in 3/5 and dural irregularity in 1/5. Tegmental defects were confirmed at surgery in all cases, demonstrating meningocele or arachnoid granulations in 2/5 and encephalocele in 2/5 patients. We recommend a combination of beta(2)-transferrin analysis to verify CSF, high resolution CT (axial and coronal planes) to diagnose tegmental defects, and MRI (multiplanar) to evaluate the type of herniation. A combination mastoid and middle fossa approach for definitive repair is suggested.
Valtonen
H
H
Central Hospital of Central Finland, Jyväskylä, and Kuopio University Hospital, Kuopio, Finland. hannu.valtonenn@kuh.fi
Geyer
C
C
Tarlov
E
E
Heilman
C
C
Poe
D
D
D000368:Aged; D000465:Algorithms; D002558:Cerebrospinal Fluid Otorrhea / Q000209:etiology* / Q000601:surgery; D004388:Dura Mater / Q000473:pathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013701:Temporal Bone / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014168:Transferrin / Q000032:analysis
D014168:Transferrin